2023 Arthur and Rochelle Belfer National Conference for Educators

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First Name

Last Name

Email (NOTE: We recommend using a personal email address vs. a work address to avoid school firewall issues.)

Address

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City

State

Province | District

Zip

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Which role best describes you?

What grade level(s) do you teach? Check all that apply.

How many years have you taught?

Have you taught about the Holocaust?

	Yes
	No
	This will be my first year teaching about the Holocaust.

Is Holocaust education mandated in your state and/or does it appear explicitly in required state standards?

	Not mandated and not in standards
	Mandated in state but not in standards
	Not mandated but in required state English Language Arts standards
	Not mandated but in required state Social Studies standards
	Not applicable (independent school)

School/Organization Name

School/Organization City

School/Organization State

School/Organization Zip Code

Is your school categorized as a Title I institution?

	Yes
	No

Describe your school. Please check all that apply.

I'd like to receive news and updates from the United States Holocaust Memorial Museum.

	Yes
	No

The virtual Belfer National Conference intends to be fully accessible for all participants; closed captioning and ASL interpretation is provided for all sessions. Sessions are recorded and available for six months, post-event. Real time participation is not required. Please let us know if there is anything else we can do to best accommodate you.

Do you have any special requests or accommodations?

	No
	Yes

How did you hear about the Belfer National Conference?

Have you attended the Belfer National Conference before?

	Yes
	No

Have you participated in any other Holocaust-related professional learning programs?

	Yes
	No

I am willing to be contacted for a post conference interview.

	Yes
	No

By attending Belfer, I agree that my name and school affiliation may be publicly announced by the United States Holocaust Memorial Museum and that this information, as well as my photograph and comments on the virtual conference platform, may be used in Museum publications, on the Museum’s website, and in any Museum video materials.

	I agree.
	I do not agree.

Date of Agreement

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