Retreat Application
Teachers for Social Justice: Deaf* Learners

Date of Conference: August 3-10, 2014        

Application Deadline: May 1, 2014
Announcement of selected candidates by June 1, 2014

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First Name *
Last Name *
Position/Grade Level *
Institution or place of work *
Work Address *
Text Phone *
Work Phone *
Work E-mail *
Email *
That you check regularly
The cost of the retreat is $1,000 TSJDL which includes housing, meals and all curriculum materials.  TSJDL will offer scholarships to offset the cost of the retreat. Would you like to be considered for a $1,000 / $500 / $250 or $100 need-based scholarship?
The retreat will be conducted in ASL.   *
Will you need accommodations (tactile/deaf/blind interpreter, assistive/adaptive technology, etc.)?
How did you hear about TSJDL? *
Please answer the following questions to the best of your ability and comfort level: *
Deaf/Hearing:
Deaf-Blind / Deaf-Low Vision / Other, Please Specify: *
Gender identity: *
Language/s: *
Nationality: *
Racial/Ethnic identity: *
Religion / Spirituality: *
Sexual Orientation: *
Socio-economic Status (SES): *
Any other socio-cultural identity group membership you feel is relevant: *
Briefly write (2 typed pages or less) or send a video (5 minutes or less) answering the following six questions.  Send your answers via email TSJDL13@gmail.com with the question number clearly stated.  Please submit your videos via youtube link, vimeo, dropbox or any other easily accessible website. *
1.  Why do you want to attend TSJDL?
2. What kinds of experiences have you had that helped you to understand social justice? *
3. In what areas of social justice do you feel you most need to grow and learn? *
4. Describe a time in which you experienced or witnessed oppression. *
5. Comment on the skills you hope to learn during the retreat. *
6. How will you apply what you learn when you return to your school communities?                     *
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