Tracey A. Benson Consulting Anti-Racism Leadership Institue
Please complete and submit this form to enroll a participant in an upcoming Anti-Racism Leadership Institute. A separate form must be completed for each participant. Space is limited and placements will be made on a first-come-first-served basis. You will receive detailed information and a payment link after your enrollment is processed. You will be notified and placed on a waiting list if an institute is full.

If you have questions please contact us at 704-363-3087 or office@traceyabenson.com

Anti-Racist Leadership Institute Rates
1 Participant with Cohort Implementation Support - 5,000
2 Participants with Cohort Implementation Support- $8,500
1 Participant with 1-on-1 Coaching Implementation Support- $5,000
2 Participants with 1-on-1 Coaching Implementation Support- $10,000

Build your own exclusive institute for school or district. Contact Melissa at 704-363-3087 or office@traceyabenson.com
First and Last Name *
Email Adress *
Phone Number *
Full Mailing Address *
How would you describe yourself? *
Which institute would you like to enroll in? *
Which implementation and support model would you like to use for this program? *
Required
Current Job Position *
Current Organization/Employer *
Do you believe you are (intentionally or unintentionally) contributing to racism in society? *
Have you ever been challenged to explore your complicity in societal racism? *
How comfortable are you with talking about racism in a multi-racial setting? *
What problem(s) in your organization do you intend to address following completion of this master course? *
Will you have access to the program fees by the following deadlines: January 2021 payment deadline- December 11, 2020, February 2021 payment deadline - January 3, 2021, March 2021 payment deadline - February 3, 2021 (Payments will be accepted by check or online via Square) Anti-Racist Leadership Institute Rates:1 Participant with Cohort Implementation Support - $5,000 | 2 Participants with Cohort Implementation Support- $8,500 | 1 Participant with 1-on-1 Coaching Implementation Support- $5,000 | 2 Participants with 1-on-1 Coaching Implementation Support- $10,000 *
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