In-School Program Interest Form

Thank you for your interest in partnering with NCCJ to bring a program to your school. Please fill out the following form so we can better meet your needs.

First Name

Last Name

Phone Number where we can reach you during the day

School Name

Position within your school

Please answer the following questions. Having this information will help us best prepare for your school's program.

Have we held an Anyday or other NCCJ in-school programs at your school before?

YesNo I don't know

Which NCCJ program are you interested in?

Full day social justice program - Anyday Seminar-style, 75-minute program - Break the Cycle I don't know

Are there any school initiatives, projects, etc., focused on diversity, equity and inclusion that you think would be helpful for us to be aware of for the program (i.e. are you all already doing something that we can refer to during the program)?

Why are you interested in bringing NCCJ programs to your students?

Anything else you'd like to share/ask us?

Contact Information