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IDSJ Summer Institute Connecticut
This is the registration form for the 2023 Institute for Teaching Diversity & Social Justice Summer Institute in Connecticut.

Greens Farms Academy
35 Beachside Avenue
Westport, CT 06838

There is a limit of 4 participants from one school/organization for each Institute.

The Institute will be held from Monday, August 7, 2023 - Friday, August 11, 2023. Days will run from 9am - 5:00pm ET. Breakfast begins at 8:30am.

If your school district requires an invoice to process payment, or if you have any questions, please contact info@idsj.us.

Health & Safety Guidelines

To protect your health and safety, and ours, each Institute will follow all required and recommended guidelines of the CDC and local jurisdiction that are in effect at the time. Participants are required to show proof of full vaccination, including all recommended booster(s), prior to attending. Proof of vaccination can be submitted by e-mailing a copy of your vaccine card to info@idsj.us, either when you register or at a later date, but no later than May 15, 2023. If at the time of the Institute you are experiencing symptoms or test positive for COVID-19, you cannot attend. With documentation (doctor’s note or positive test result showing your name and test date), we will hold a place for you in a 2024 Institute or refund your fees, less 10% for processing.

Refund Policy

A refund of registration costs (less a 10% administrative fee) can be requested through May 15, 2023 by emailing info@idsj.us. No refunds will be issued after May 15, 2023 unless due to Covid-19 as stated above. However, participant substitutions are allowed. In addition, registrants needing to cancel after May 15, 2023 should contact info@idsj.us to have their registration fee applied toward a summer 2024 IDSJ event offering (if interested).
Are you registering for yourself or someone else?

I am registering myself.I am registering someone else.
Name of Registrant*

First NameLast Name
Pronouns (If you prefer not to say, please write "prefer not to say)."*
Race/Ethnicity*

African American/Black/Afro Latino/CaribbeanAsian/Asian AmericanBiracial/MultiracialHispanic/Latino/a/xIndigenous/NativeWhite
If none of the categories above accurately reflect your identity, and you would like to provide more specificity, please do so here.
Religious/Spirituality Affiliation*

Atheist/unaffiliatedBuddhismChristianHinduismIndigenous SpiritualitiesJudaismMuslimPrefer not to share
If none of the categories above accurately reflect your identity, and you would like to provide more specificity, please do so here.
Sexual Orientation*

AsexualBisexualGayHeterosexualLesbianPansexualQuestioningPrefer not to share
If none of the categories above accurately reflect your identity, and you would like to provide more specificity, please do so here.
Please tell us your Gender Identity*
School/Organization*
What is your primary title/role*

Educator (Early Childhood)Educator (K-5)Educator (3-5)Educator (6-8)Educator (9-12)AdministratorCurriculum SupervisorDirector of DiversityInstructor/Administrator Community CollegeNot currently employed
What is your Secondary Title/Role (if any)

Educator (Early Childhood)Educator (K-5)Educator (3-5)Educator (6-8)Educator (9-12)AdministratorCurriculum SupervisorDirector of DiversityInstructor/Administrator Community CollegeNot currently employed
What is your subject area (if applicable)?
Please provide any further descriptions of your title/role(s).
School E-mail (if currently affiliated with a school)*
example@example.com
Work Phone Number

Area CodePhone Number
Cell number (where we can contact you during institute)*

Area CodePhone Number
Work Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Have you attended other Professional Development sessions related to Anti-Bias/Anti-Racist/Social Justice Education?*

YesNo
If you answered "Yes" to the previous question, please briefly explain those experiences.
PHOTO/FILM RELEASE

By checking “yes” below, I hereby give Educational Resource Group LLC the absolute and irrevocable right and permission, with respect to video and photographs that its employees and volunteers may take of me during the program for which I am registering, via Zoom,

(a) to copyright the same in the name of Educational Resource Group LLC and/or Khyati Y. Joshi;
(b) to use, re-use, sublicense to other entities, publish and republish the same, in whole or in part, individually or in conunction with other photographs or images, in any medium, including but not limited to print, video, or the Internet, for all purposes including advertising, trade, or any commercial purpose throughout the world and in perpetuity.

I hereby release and discharge Educational Resource Group LLC, its officers, members, employees, agents, successors, and assigns, from any and all claims and demands arising out of or in connection with the use of such photographs, film, or tape, including, but not limited to, any claims for defamation or invasion of privacy.
I hereby consent to the release of said video, audio, film, photographs or any other medium for the above-stated purposes and in accordance with the terms stated above.

I am of legal age and have read the foregoing and full understood its contents.
Do you agree to the photo/film release?*

Yes
Important Information RE: Payment

Our preferred payment method is below. If your school cannot complete electronic payment transactions and you need to pay by check, please email info@idsj.us after registering. Please note that your spot will not be secured until payment is received.
I understand that I am registering for the IDSJ Summer Institute in Connecticut.*

Yes

Regular Registration for Summer Institute CT$1,500.00

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IDSJ Summer Institute Connecticut