2023 TEEN CIVIL RIGHTS JOURNEY TO THE SOUTH APPLICATION FORM

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2023 TEEN CIVIL RIGHTS JOURNEY TO THE SOUTH APPLICATION FORM

Thank you for your interest in our program. The trip is now full, but if you fill out and submit the information below and you will be added to our Waiting List. Frequently students’ plans change, and we will contact you as places become available. For additional information contact Tina Keller at [email protected]

About the trip:

The Teen Civil Rights Journey to the South is one in which you will be educated, inspired and empowered. While traveling to Atlanta, Ga., Montgomery and Birmingham, Al., you will meet with Reverends who worked and strategized with Dr. Martin Luther King as well as people who participated in the historic March from Selma to Montgomery. These are primary sources. Each meeting will ensure that you understand that you can make a difference today. We will discuss Jewish involvement in the Civil Rights Movement of the 1950s and 60s, and how our Passover story correlates so strongly with the Civil Rights story. By visiting the Equal Justice Initiative, we help you understand that Civil Rights is not an issue that only impacted specific people in the 1950s & 60s, but is an ongoing issue today - being fought for by a variety of groups that have not felt they had a voice in the world. In the end our hope is that you will become inspired to return home and get involved, realizing you have the power to make a difference.

2023 Dates - November 5-7, 2023 (Sunday-Tuesday)

STUDENT INFORMATION

First Name*

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Last Name*

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Date of Birth*

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Grade as of September 2023*

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Student Phone

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Student Email

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Student School*

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Synagogue *

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PARENTS INFORMATION

Parent 1 First Name*

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Parent 2 First Name*

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Parent 2 Last Name*

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Parent 1 Phone*

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Parents 2 Phone*

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Parent 1 Email*

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Parents 2 Email*

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Address*

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City*

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State*

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Zip Code*

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In Case of Emergency, Person to Contact (If Not Parents)*

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PARENT OR GUARDIAN SIGNATURE

Parent or Guardian, Print Your Name and Date*

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2023 TEEN CIVIL RIGHTS JOURNEY TO THE SOUTH APPLICATION FORM