Thank you for your interest in hosting a Holocaust Symposium for Teens. Please complete this application. Deborah Coltin, Executive Director of Lappin Foundation, will contact you after your application has been reviewed.

Name of School or Organization *

School or Organization Address*

School or Organization City*

School or Organization Zip*

School or Organization Phone*

Name of person completing the application*

Title*

Address*

City*

Zip Code*

Phone*

Email*

Tentative dates/time of year you would like the symposium*

Estimated number of participants*

Why do you want to host the Holocaust Symposium for Teens?*

Would you like a trained facilitator or do you have someone in mind you would like to be trained as the facilitator?*

Is there anything else you would like us to know? *

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