Introductory Social Justice Leadership Institute: Fall 2019 School Registration Form
Thanks for your interest in attending the Social Justice Leadership Institute! Our Introductory fall retreat takes place Saturday and Sunday November 2nd - 3rd, 2019 at Phillips Academy Andover! SJLI focuses on social identity development, expanded political analysis, personal leadership skills and network transformation tools. This interactive two-day overnight retreat brings together ~60 ninth - twelfth grade Independent school student leaders from across New England. Our experienced staff team of activist educators supports this group to connect, learn and act.

Please complete this school registration form to confirm your school's participation. By filling out this registration form, you commit to participating in the November 2019 Introductory Social Justice Leadership Institute. The deadline to complete this school registration form is Friday, October 25th. Early Bird student registration is $400/student. To secure the Early Bird rate, please complete this form by Friday, October 4th. Regular student registration is $475/student and open until Friday, October 25th. All final payments are due no later than Friday, November 1st.

The participation fee for your school is based on the numbers you provide in this document. An invoice will be sent to you following your completion of this school registration form. Please note: the invoice will be based on the numbers of participants that you provide in this form.

After receiving your completed school registration form, we will send you a brief student registration form to confirm the final names of student participants from your school. You will need to confirm specific student participant names by Monday, October 28th. If your school ends up having fewer student participants attend than the projected number provided on this registration form, please note: your invoice and registration fees will reflect the number you provide on this school registration form.

Please reach out to Mariko Dodson with any additional questions at mariko@bostonmobilization.org 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? *
Schools are invited to send a minimum of 3 and a maximum of 10 students. We strongly recommend that the cohort is majority students of color. We encourage that the cohort is diverse with respect to ethnicity, class, gender and sexual orientation and also with respect to class year (first-year, sophomore, etc). The specific application process for the cohort from your institution is up to you.
How many students from your school will participate? *
This is the total number of spaces we will reserve for your school. The participation fee for your school is based on the numbers you provide in this form. An invoice will be sent to you following your completion of this School Registration form. Please note: the invoice will be based on the numbers of participants that you provide below. Final registration for each participating student is due October 29th. Please contact Mariko (mariko@bostonmobilization.org) 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 agree to the following chaperone policy? *
Chaperones are required for student drop-off Saturday morning, pick-up Sunday afternoon, and to be on call for emergencies. Chaperones will receive materials about the Institute one week ahead of time. We will provide chaperones who wish to stay on-site during the program with a designated space on campus where chaperones will be able to hang out, read, work, nap, etc. Upon your completion of this form, we will ask you to provide emergency contact information (name and cell phone number) for your school's chaperone so that our staff can be in touch with your chaperone over the weekend in case of an emergency. Chaperones are welcome to leave campus during the program, should they wish to do so, but will be asked to stay in the area in case of an emergency. Chaperones must arrange their own Saturday overnight sleeping accommodations if they do not wish to sleep on campus (think sleeping bags on the floor!) with students and staff.
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. Should your school cohort no longer be able to attend SJLI, the following cancellation charges will apply. Cancellation notice given before October 12th will not incur any fee. Cancellation notice given before October 19th will incur 50% of the invoiced fee. After October 20th, the full fee will be due. Should your school cohort no longer be able to attend SJLI, you may be able to transfer your reservation to a future SJLI retreat.
Do you have any other questions or comments? We can 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 1st, 2019.

We will also send you our brief student registration form. Your completed student registration forms are due by Monday October 28th. Please be in touch with any questions. Thank you!

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