Highlander Research and Education Center - Social Change Workshop Online Application Form

1959 Highlander Way · New Market, TN 37820 · phone: (865) 933-3443 · fax: (865) 933-3424
e-mail: hrec@highlandercenter.org

Highlander Social Change Workshop
Online Application Form

To attend the Highlander Social Change Workshop, please fill out the form below and click on the "Submit" button at the bottom of the page.

If you would like to be considered for a scholarship, please fill out the scholarship section and submit the form by October 30, 2008.

(If you have any difficulties using this form, please contact our Webmaster at charlie at highlandercenter.org.)

Note: Fields marked with an * are required.

Application Form

*Name(s):

Organization:

Street Address:

City:

State:

Zip Code:

Telephone:

Fax:

*E-mail Address:

Race/Ethnicity:

Age:

Please tell us about your area of work or interest:

What would you hope to learn at this event?

What can you share?

In what language would you like to participate?
English Spanish Both

Scholarship Request

Would you like to be considered for a scholarship?
Yes No

If you answered "yes," please answer the questions below.

Our scholarships are limited, so we are prioritizing low-income people who are engaged in popular education and/or organizing. Please describe yourself in light of this - who are you working or volunteering with and what is this group working to do?

Please let us know what you can afford to pay.

Send us your application.

Click the "Submit" button to send us your application. Click the "Reset" button to clear the form and start over.

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Highlander Social Change Workshop Online Application Form

Highlander Social Change Workshop
Online Application Form