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* 1. First and Last Name

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* 2. Address (Street, City, State, Zip)

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* 3. Cell Phone

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* 4. Email address

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* 5. Are any of your parents/grandparents Holocaust survivors?

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* 6. If yes, which of the following exist for your relatives? If no, thank you for your time.

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* 7. Are you able to make time on an occasional basis to speak to
student groups during school hours, or potentially evening and weekend youth groups?

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* 8. Please tell us why you wish to educate students about your relatives's experiences during the Holocaust?

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* 9. Is there anything else you would like to tell us....

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* 10. Can you commit to attending at least eight of the ten sessions that run between January and April (Jan. 7, 28, Feb. 11, 25, Mar. 4, 11, 18, 25, April 1, 8 from 4 to 6 p.m. at the Stan Greenspon Center for Peace and Social Justice at Queens University of Charlotte.

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