Second Generation Speakers Bureau Form

Name *

School or Organization *

School or Organization Address

Work Email *

Work Phone *

Home Address

Personal Email

Home Phone

Cell Phone

Grade level and discipline

Please provide the number of students/participants. If you are an educator, please provide the number of adult supervisors (1 per 15 students please). This program is appropriate for 7th grade and up only.

Indicate 3 possible date and time preferences. Our speakers are able to make single one-hour presentations, so if multiple classes are to hear the speaker, they must be pulled together into one group.

Number of Students/Participants *

Number of adults

Scheduling preference #1 *

Scheduling preference #2 *

Scheduling preference #3

Please provide the following information about your classroom instruction if you are a 7th-12th grade educator.

Briefly describe your Holocaust unit including the main texts, readings, and audio-visual materials you use.

Briefly describe how you plan to address this experience in your classroom following the program.