SJLI School Participation Form
Thank you for your interest in attending the Social Justice Leadership Institute (SJLI) on the weekend of October 21st and 22nd hosted by St. Paul's School! As you know, SJLI focuses on individual identity development, expanded political analysis, personal leadership skills, and network transformation tools. Our two-day interactive overnight retreat will bring together 60-80 young people from New England Independent schools. An experienced, multiracial staff team will support this group to learn, connect, and act.

Please fill out this form to confirm your school's participation. By filling out this registration form, you are making a FIRM commitment to participate in SJLI in October 2017. The deadline for registration is Wednesday, October 4th.

The full 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 rate is $295/participant. The regular fee is $350/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 Tuesday, September 18th. All final payments are due no later than the dates of the Institute.

Final names of participants, chaperone(s), and a brief student/chaperone intake form ( will be due on Wednesday, October 18th.

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 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. The specific names are not required until October 18th. We use these numbers as serious commitments and will indicate your school's fee. Please contact Nadia ( immediately if there are any changes.
Do you plan for participants to stay overnight? *
Students must provide their own sleeping materials. Schools electing not to stay overnight are expected to stay at SPS until 10PM Saturday and return no later than 9AM on Sunday.
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 before.
We expect our chaperone to volunteer for overnight duty. (If so, the $50 chaperone fee is waived) *
Chaperones must arrange their own housing if not signing up for overnight duty.
Do you agree to the following cancellation policy? *
The Institute requires a lot of 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 1 week prior to the start of the Institute.

Please have all confirmed students and your chaperone complete the following brief registration form by October 18th at

Please be in touch with any questions!

Thank you!

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