KESHET REGIONAL TRAINING INSTITUTE
First Name:
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Last Name:
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Home Address Line 1:
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Home Address Line 2:
City:
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State:
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Please Select
Alabama
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Zip Code:
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Phone:
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Alternative Phone:
E-mail:
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I am interested in attending:
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Cleveland 7.13-15
Name of Jewish institution/organization with which you are affiliated:
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Institution Address:
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City:
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State:
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Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code:
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Job Title:
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Movement affiliation (if any):
Please identify the setting in which you work. [Check all that apply.]:
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Jewish Day School
Jewish Summer Camp
Synagogue Religious School
Jewish Youth Group
Hebrew High School
University Hillel
Other (please describe below)
If you checked other, please describe here:
What ages are the youth with whom you work? [Check all that apply.]:
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Early childhood
Grades K-5
Grades 6-8
Grades 9-12
College
Have you participated in any gay, lesbian, bisexual, or transgender (GLBT) diversity programs?
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Yes
No
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?
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What experience, if any, do you have leading professional development training?
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What kind of experience do you have in Jewish educational settings (both as a professional and/or as a student)?
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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?
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What experience, if any, do you have working on issues related to sexual orientation?
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What experience, if any, do you have working on gender identity issues?
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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:
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Phone Number:
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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?
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