2008 Regional Training Registration

KESHET REGIONAL TRAINING INSTITUTE
First Name:*
Last Name:*
Home Address Line 1:*
Home Address Line 2:
City:*
State:*
Zip Code:*
Phone:*
Alternative Phone:
E-mail:*
I am interested in attending:*

Cleveland 7.13-15
Name of Jewish institution/organization with which you are affiliated:*
Institution Address:*
City:*
State:*
Zip Code:*
Job Title:*
Movement affiliation (if any):
Please identify the setting in which you work. [Check all that apply.]:*

Jewish Day SchoolJewish Summer CampSynagogue Religious SchoolJewish Youth GroupHebrew High SchoolUniversity HillelOther (please describe below)
If you checked other, please describe here:
What ages are the youth with whom you work? [Check all that apply.]:*

Early childhoodGrades K-5Grades 6-8Grades 9-12College
Have you participated in any gay, lesbian, bisexual, or transgender (GLBT) diversity programs?*

YesNo
If yes, please explain the type of diversity training you have had and the context of your participation (i.e., as part of pastoral counseling program, or a workshop by a GLBT organization):
Why are you interested in becoming a Shalem Education Project Regional Facilitator? *
What experience, if any, do you have leading professional development training?*
What kind of experience do you have in Jewish educational settings (both as a professional and/or as a student)? *
As part of the Shalem Education Project workshops, facilitators must be comfortable discussing their Jewish identity and helping educators understand links between Jewish values and GLBT inclusion. The facilitator training will provide you with skills and suggested texts and activities.
Would you be comfortable discussing Jewish identity and texts as part of a Shalem Education Project workshop ? Why or why not? *
What experience, if any, do you have working on issues related to sexual orientation?*
What experience, if any, do you have working on gender identity issues?*
By participating in this program, you are committing to bring Shalem Education Project workshops and materials to your community and the institution or organizations with which you are affiliated. To ensure that you have support from the leadership at your organization or institution, we suggest that you initiate a conversation with them to discuss ideas for bringing the programs to your community. Keshet staff is happy to assist you with materials to support you. We also ask that you list the name and position of the person with whom you have discussed your participation in the Shalem Education Project Training Institute.
Name and position of representative from your organization:*
Phone Number:*
What is your plan/vision for implementing the skills and materials you learn that the Training Institute into your work with Jewish youth?
Is there anything else you would like to add?
Should be Empty:

KESHET REGIONAL TRAINING INSTITUTE