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 2018 at Phillips Academy Andover! 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 high school student leaders from top New England Independent schools. Our experienced 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 participating in the November 2018 Social Justice Leadership Institute. The deadline for school registration is Friday, October 26th.

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.

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 Friday, October 5th. 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 the specific student participant names by Monday, October 29th. If your school ends up having fewer student participants attend than the projected number provided on this registration form, please note: your invoice and expected fees will reflect the number you provide on this School Registration form.

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? *
Schools are invited to send a minimum of 4 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 ( 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. Should your school cohort no longer be able to attend SJLI, the following cancellation charges will apply: If you give us notice that you will need to cancel before October 19, you will not charged a fee. If you have to cancel between October 20 to 26, 50% of invoiced fee will be due. After October 27, the full fee will be due.
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 3rd, 2018.

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

Please be in touch with any questions. Thank you!

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