Complete this form and return it to: Debra Berghoff MN Center for Community Legal Education University of Minnesota  270B McNamara Alumni Center 200 Oak Street SE Minneapolis MN  55455 Or fax it to Debra at:612/624.6905

For questions contact Debra at: 612/624.8112  or to bergh004@umn.edu

Project Citizen Registration

Name____________________________________________________________________________________

School___________________________________________________________________________________

Address__________________________________________________________________________________

_________________________________________________________________________________________

Phone______________________________________ Fax__________________________________________

E-mail___________________________________________________________________________________

Grade Level of Class:____________Class (i.e., civics):____________________________________________

Total numbe of classes participating: ____________________Average number of students per class ________

Type of School (circle):     Public       Parochial       Private       Home

Tell me more about (circle all that apply):
        in-service training       a summer institute    a simulated legislative hearing       academic showcase

Signature_________________________________________________________Date_______________________________
 

I am interested in using Project Citizen with my students.
Please send me a Project Citizen student text to review.