Social Justice Leadership Institute Fall 2018 School Registration Form
Thank you for your interest in attending the Social Justice Leadership Institute (SJLI) on the weekend of November 3rd and 4th at Phillips Academy Andover! As you know, this weekend Institute focuses on student identity development, expanded political analysis, personal leadership skills, and network transformation tools. Our two-day interactive overnight retreat will bring together 60-80 high school student leaders from top New England Independent schools. Our experienced, multiracial staff team of educators and activists will support this group to learn, connect, and act.

Please complete this school registration form to confirm your school's participation. By filling out this registration form, you commit to participation in the November 2018 SJLI. The deadline for registration is Monday, October 22nd.

The participation fee for each school is based on the numbers you provide in this document. An invoice will be sent to you within a week of you completing this form. The Early Bird fee is $350/student participant. The regular fee is $425/student participant. There is a $50 fee for each chaperone (chaperone fee is waived if chaperones volunteer for overnight duty). To secure the Early Bird rate, you will need to complete this form by Monday, October 1st. All final payments are due no later than Saturday, November 3rd.

After receiving your completed School Registration Form, we will send you a brief Student/Chaperone Registration form to confirm the final names of student participants and chaperone(s) from your school. You will need to confirm participant names by Monday, October 29th.

Please reach out to Mariko Dodson with any additional questions at or 617-492-5599.

We look forward to working with you and your students!

Name of school *
Your answer
Name of primary contact person *
Your answer
Role/Title of contact person *
Your answer
Email address of contact person *
Your answer
Phone number of contact person *
Your answer
Do you commit to meeting the following criteria in your recruitment of student participants? *
First year schools are invited to send a minimum of 4 and a maximum of 7 students. We strongly recommend that the cohort includes a minimum of 1 white student and 2 students of color, a diverse range of grades, and is diverse with respect to ethnicity, class, gender and sexual orientation. The specific application process for the cohort from your institution is up to you. Returning schools may elect to send up to 10 students.
How many students from your school will participate? *
This is the total number of spaces we will reserve for your school. Final registration of participating students is due October 29th. We will use these numbers to determine your school's participation fee. Please contact Mariko ( immediately if there are any changes.
Do you plan for participants to stay overnight? *
Students must provide their own sleeping materials (pillow, sleeping bag, sleeping mat) while Phillips Academy Andover will provide on-site sleeping space with breakout sleeping areas separated by gender. Meals will also be provided on-site. Schools electing not to stay overnight are expected to stay at Phillips Academy Andover until 10PM Saturday evening and return to campus no later than 9AM on Sunday morning.
Do you commit to providing at least one chaperone for the Institute? *
We ask each institution to provide one chaperone. Chaperones will receive materials about the Institute one week ahead of time. It can be helpful if chaperones are willing to engage with the material and offer a listening ear to students looking for some extra debrief or processing support.
We expect our chaperone to volunteer for overnight duty. (If so, the $50 chaperone fee is waived.) *
Chaperones must arrange their own overnight housing if they are not signing up for overnight duty.
Do you agree to the following cancellation policy? *
The Institute requires much logistical planning and support to create the highest quality experience for all students. Because of this, the following cancellation charges will apply: Notice of 7-14 days in advance, 50% of agreed upon fee will be due. 7 days or less notice in advance, full fee will be due by scheduled date of the engagement.
Do you have any other questions or comments? We can always be reached at Boston Mobilization at 617-492-5599.
Your answer
What's Next?
An invoice will be sent to you based on the numbers you've indicated in this form. Payment is due by November 3rd, 2018.

We will also send you our brief Student/Chaperone registration form. Your completed Student/Chaperone registration form is due by October 29th.

Please be in touch with any questions. Thank you!

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