STUDY CIRCLES ENROLLMENT FORM

Yes, I would like to participate in study circles on race and ethnic relations in Jacksonville, which the Jacksonville Human Rights Commission (“JHRC”) will be commencing in the Fall 2021.

I understand that this is a voluntary process and that a study circles group (consisting of 8 to 12 participants and 1 to 2 facilitators) will meet for 2 hours per week over a period of 5 weeks. JHRC will add my name to the list of interested persons and contact me when a study circles group becomes available.

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* 1. Name

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* 2. Phone number:

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* 3. Email address:

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* 4. Zip Code (in order to schedule a convenient location for participants):

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* 5. I am available for study circles meetings during the following time periods (please check all that apply):

Weekday (Mon. thru Fri.) - late morning/early afternoon (11:30 a.m. to 1:30 p.m.)

Weekday (Mon. thru Fri.) - late afternoon/early evening (4:00 to 7:00 p.m.)

Weekend (Saturday) - morning (9:00 a.m. to 12:00 p.m.)

Weekend (Saturday) - afternoon (12:00 to 5:00 p.m.)

Other (please specify)

STUDY CIRCLES ENROLLMENT FORM

Question Title

* 1. Name

Question Title

* 2. Phone number:

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* 3. Email address:

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* 4. Zip Code (in order to schedule a convenient location for participants):

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* 5. I am available for study circles meetings during the following time periods (﻿please check all that apply﻿):

* 5. I am available for study circles meetings during the following time periods (please check all that apply):