Application - Madison Wisconsin Institutes for the Healing of Racism, Inc.
Weekly meetings 6-8 pm for ten weeks. Choose either Wednesdays (February 15 – April 26) or Thursdays (February 16 – April 27). Note there is no class the week of April 10-14 due to MMSD spring break.
A ten-week commitment is required for full understanding and impact. Please wait until the fall series if you believe you may miss more than two sessions this spring.
Registration Fee $50.00 (need-based scholarships are available. For scholarship info, contact
Payment will be accepted once your enrollment is confirmed.
Preferred First Name
Enter your legal name, nickname, or preferred name
Enter your last name
Enter your email address
Address Line 1
Enter your street address or PO Box
Address Line 2
Enter apartment, suite, unit, building, floor, etc.
Enter your city
Select your state
ZIP / Postal Code
Enter your ZIP / Postal Code
Primary Phone Number
Enter your primary phone number, including area code (e.g., 608-466-2853)
Alternate Phone Number
Enter an alternate phone number if you have one (include area code)
Enter your age using only numbers (you must be 16 or older to participate)
Enter your ethnicity or ethnicities
Are you a past participant?
If yes, would you be willing to share your experiences from past sessions with the group?
How did you hear about the Spring 2017 series?
Which day works best for you?
Waiting list - Wednesdays
Waiting list - Thursdays
What do you expect/hope to get out of participation in the Institutes?
Will you have any barriers to accessing online assignments during the 10-week session? If yes, please explain.
Gender Pronoun Preference
Select your preferred gender pronouns from the list or choose "Other" and indicate your preference
she / her / hers
he / him / his
ze / hir / hirs
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