Mandel Center On-site Program Request
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Name of instructor (first name) *
Name of instructor (last name) *
Name of point of contact (if different than instructor)
Email *
Cell phone *
Name of institution *
Institution type (please check all that apply) *
Required
Course or institution department *
If you are a non-university group, please indicate your group's institutional affiliation/title.
Course title (please indicate "NA" if not applicable)
Course level *
Number of people in your group *
The Museum advises groups of 40 or more to use our online group reservation system. For further information, please visit ushmm.org/plan-a-visit.
Total number of students enrolled in the course *
Requested time/date of program (*please note it may not be possible for us to accommodate requests made fewer than 4 to 6 weeks in advance of the visit) *
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DD
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Time
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Type of program (please check all that apply) *
For further information about passes to the Permanent Exhibition, please visit ushmm.org/plan-a-visit.
Required
Which of the following debrief topics would best complement your course goals (please select one or two options)? *
Required
In what ways would a debrief on the above-selected topic(s) complement your course objectives? *
Please describe your prior contact with the Mandel Center (please check all that apply) *
Required
This is my first visit to USHMM
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Please describe how you heard about this program
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