Tracey A. Benson Consulting Anti-Racism Leadership Institute - REGISTRATION FORM
IMPORTANT INFORMATION- PLEASE READ BEFORE COMPLETEING THIS REGISTRATION FORM

Overview- This comprehensive program is designed to help education leaders build knowledge, skill, and ability, while concurrently developing a concise, high-yield plan of action to increase
racial equity. This two-part program includes a 40-hour Anti- Racist Master Class as well as ongoing coaching and implementation support.

Rates - This program can be highly customized. The costs can range anywhere from $5,000 to $50,000+ based on the number of participants from your school or district, the implementation model that you choose, and if you choose to couple the institute with racial equity audits, racial climate surveys, or other consultive work. The best way to get an accurate estimate of costs is to schedule a time to discuss your specific needs. Please use this link to schedule a consultation - https://calendly.com/melissamcdaniel360/30min

If you are enrolling 8 or more participants you are a candidate for building your own exclusive institute for your school or district. Contact Melissa at 704-363-3087 or office@traceyabenson.com for details.

Enrollment - 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

THIS IS A REGISTRATION FORM. UPON COMPLETION YOU WILL BE REGISTER FOR A COHORT OR THE WAITING LIST. IF YOU WOULD LIKE TO DISCUSS DETAILS BEFORE REGISTERING PLEASE EMAIL office@traceyabenson.com or schedule a meeting at https://calendly.com/melissamcdaniel360/30min (copy and paste into browser)



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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 at least 14 days before the start of the program? (Please see the fee information in the description) *
Is there more than one person from your school/district/organization enrolling in this program? *
Please make sure that you have read the information in the description at the beginning of the form before submitting your registration. We look forward to working with you. - The Tracey A. Benson Consulting Team
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