Personal Information

*REQUIRED FIELDS
Name*
Home Address 1*
Home Address 2
City*
State*
Zip Code*
Home Phone*
Cell Phone
Home E-Mail

 

School Information

School Name*
Address 1*
Address 2
City*
State*
Zip Code*
School Phone*
School E-Mail

 

Holocaust Conference Request (Select Only One)

         

U.S. Holocaust Memorial Museum Belfer I (Washington, DC) Belfer Next Step (Washington, DC) Museum Teacher Fellowship (Washington, DC) Appalachian  State University Martin & Doris Rosen Summer Symposium (Boone, NC) Jewish Foundation for the Righteous Summer Institute for Teachers  (New York City) Advanced Seminar (Newark, NJ) European Study Program Facing History and Ourselves Holocaust & Human Behavior (Memphis, TN) Yad Vashem International Seminar, Summer (Jerusalem) International Seminar, Winter (Jerusalem) Jewish Educators Seminar, Summer (Jerusalem) Jewish Educators Seminar, Winter (Jerusalem) Other Name of Institution   Name of Conference Secular Teaching Experience Please provide information beginning with the most recent and working backwards.                 School 1 *   Grade(s) *         Subject(s) *   Calendar Year *                   School 2          Grade(s)     Subject(s) Calendar Year                 School 3          Grade(s)      Subject(s) Calendar Year     If experience is more extensive, please enter in box below. Follow above format. Holocaust Teaching Experience Please provide information beginning with the most recent and working backwards. Number of years teaching the Holocaust*                      School 1       Grade(s)      Calendar Year School 2       Grade(s)      Calendar Year School 3       Grade(s)      Calendar Year Please describe the content and any special experiences that were included in your Holocaust Unit. (i.e. student assignments, field trips, etc.)   Previous Holocaust Education Conferences You Have Attended. Conference     Date Conference     Date Conference     Date   Required Essay Please submit the required essay. You may use the text box below. Describe briefly (500 words or less) your reasons for requesting grant support to attend the Holocaust Conference you have selected. Principal Recommendation A recommendation from your Principal is required. Please submit by mail or email by the Application Deadline. Email: Scholarship@bhamholocausteducation.org Mail: Birmingham Holocaust Education Committee P. O. Box 130805 Birmingham, AL 35213-0805

        

---