Workshop Request – Education Grant

Please fill out this form in order for us to be able to organize your requested workshop.

Name of Requesting Organization*
Contact Name*
First Last
Address*
City Province
Work Phone*
Cell Phone
Email*
Choose Your Workshop*
- Educators: A Teachable Moment About Islamophobia (1.5-2.5 hours)
- Students: Say Salam - Islamophobia and Bystander Intervention (45-60 min)
- Students: Representation in the Media (45-60 min)
- Students: Fake News- How to determine what is real and what is not (45-60 min)
Suggested workshop dates:*
MM slash DD slash YYYY
MM slash DD slash YYYY
MM slash DD slash YYYY
Time of Workshop*

:

AM/PM
Location of Workshop*
City Province
Anticipated Size of Audience*
Please provide additional information about the audience. (For teachers, which grade levels they teach; for students, indicate to which grade(s) they belong).*
What are some questions you hope this workshop will answer?
Do you require any special accommodations to ensure full participation from audience members?
Is this workshop part of a larger event/conference?*
- Yes
- No
If yes, provide details on Program Segments and Speakers:
If no, would you like to take advantage of our $5/person food subsidy?*
- Yes
- No
*subject to availability
Receive NCCM Community Updates
- Yes please!
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