Day of Deliberative Dialogue - Regional Registration

Please complete the form below to register and participate in A Day of Deliberative Dialogue. Through respectful dialogue, we aim to return the “civil” into public discourse. These events are part of Close Up Foundation’s NextGen Roundtable: America 250, a growing initiative to honor the Semiquincentennial of the United States through classroom resources, professional learning opportunity, and regional and national deliberations that connect our founding principles to the policy issues of today.

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Which, if any, of the following civics-related clubs or activities do you participate in?

What motivated you to participate in A Day of Deliberative Dialogue?:

Promoted by a club/class

Requirement of a club/class

Interested in learning deliberative skills

Other

Demographic Questions

For educational and funding reporting purposes, Close Up requests that you provide the following demographic information. Such information will remain confidential and will not be used at any time for selection or placement criteria for the Close Up programs. Please complete all items below. Your cooperation is greatly appreciated.

Are you a member of a farm/migrant community?

Yes

Which best describes your school district?

Which best describes you? (please select one or more)

American Indian or Alaska Native

Asian

Black or African American

Hispanic or Latino/a

Middle Eastern or North African

Native Hawaiian or Other Pacific Islander

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Is the Participant 18 years of age or older at the time of signing this agreement?(Required)

Yes

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Student Terms(Required)

I have read and agree to the Teacher Terms and Conditions .

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I have read and agree to the School Terms and Conditions.

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Topic (CRM)

A Day of Deliberative Dialogue Regional Registration

Demographic Questions