Program Request Form

We appreciate you reaching out to the Peace & Justice Center. We are happy to explore the possibility of bringing our educational programs to your organization.

Expect a follow-up email soon. If you have any questions, please contact us at program@pjcvt.org

Contact Information

Organization name

Preferred Name of Contact

First Name

Last Name

Contact's Role/Title

Verify Email

Website Address (if applicable)

Phone number

Organization Address or P.O. Box Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Agency Information and Program Logistics

What made you decide to reach out to the PJC?

Example: Is your request the result of racist incidents within your organization? Has this program been requested by others within your organization?

Has your organization done any kind of Diversity, Equity, Inclusion (DEI) work?

Training, workshops, etc.

Who is the anticipated audience for this workshop and how many people will be present? Will this be mandatory (for staff, volunteers, board memebrs, etc)?

Does you organization have a DEI director, committee, or system for addressing DEI

What are you hoping to walk away with after working with us?

Does you organization have a DEI statement or address DEI in the mission statement?

If yes, please paste statement here

Do you have a specific date(s) in mind for the program or service?

What times would you want to have the event?

*You many choose multiple options. Many our facilitators work 9-5 jobs and it may take longer to schedule weekday day events.

Weekday Days (9-5)

Weekday Evenings (after 5)

Weekend Days (9-5)

Weekend Evenings (after 5)

Where do you prefer this event to be hosted?

*Hybrid Policy: Clients who wish to host hybrid events must supply the appropriate technology for a hybrid event. The PJC staffers determine appropriateness. Additionally, hybrid events require workshop customization and additional PJC staff. Please be aware these factors will increase the workshop's pricing.

Virtually

In-person

Hydrid

(If in-person) Do you have a room large enough to hold all participants, PJC educators, and have extra space for breakouts?

*Indoor Workshop Policy: Regardless of the weather, we always ask to have an indoor space to present. We will need a large enough space to have everyone in small groups at tables, the facilitators up front, some extra space in the back for small groups to break out, and an additional room for affinity spaces of facilitators to take a private break. Will yo

Program(s)

*We offer economical, social, and environmental justice educational programs. Please select one or more programs you are interested in.

Racial Justice Program(s)

See link in description above for descriptions. Check all that apply.

Seeing and Disrupting Racism (2 hours)

Building Empathy & Addressing Racial Oppression (6 hours)

Talking With Kids About Racism (6 hours)

Unpacking Whiteness (2 Hours)

Social, Racial, and or Environmental Justice Book Discussion

Social, Racial, and or Environmental Justice Film Screening

Fair Trade Program(s)

See link in description above for descriptions. Check all that apply.

Fair Trade 101 (2 Hours)

Fair Trade Book Discussion

Fair Trade Film Screening

Other Program(s)

See link in description above for descriptions. Check all that apply.

Environmental Justice 101 (2-hours)

Customized Workshop: Current Events, Hot-Button Topics, and Dynamic Conflicts (varied)

If other, please explain?

Budget

Is your organization a for profit or not for profit organization?

For Profit

Not for Profit

Other

If other, please explain.

In order to determine the cost of this program, we would like to know your organization's annual operating budget

Consider any budget that you may have access to. We define frontline groups as those directly impacted by the issues we are addressing.

$1,000,000 +

$500,000 - $999,999

$250,000 -$499,999

$100,000 - $249,999

We are a frontline group or have an annual budget under $100k

Other

Do you have any other questions, concerns, and/or information that would be helpful to for us to know or address?