Virtual Survivor Testimony

Virtual Survivor Testimony

Fill out the form below to virtually welcome Holocaust survivors into your classroom or home. Program intended for groups of students (grades 7-12+) and the general public with a minimum of 15 participants.
Requirements:

Minimum 15 people

Zoom functionality

Disclaimer:

Dates and times are subject to availability. Please submit your request at least two weeks in advance of your preferred date.
Name*

First NameLast Name
Email*
example@example.com
Phone Number
Please enter a valid phone number.
Who is your session intended for?*
Name of School / Organization / Group*
School Board
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
If you indicated your session was for students in the previous question, please identify the grade / ages below:

Grade 6Grade 7Grade 8Grade 9Grade 10Grade 11Grade 12University
Indicate the number of people participating (minimum 15)*
Preferred Date (excluding Friday evenings and Saturday)*

MonthDayYear
Date
Alternate Date (excluding Friday evenings and Saturday)*

MonthDayYear
Date
Time (sessions are only available between 9:30am - 7:30pm (final start time))*

Hour Minutes

AM/PM Option
Please provide any relevant background information (extent of knowledge on the Holocaust, has it or will it be covered in class etc.)
Additional information or questions:
Should be Empty: