Speaker Request Form

If you prefer, you can download a copy of the form to email or print and mail in.

“In all of us there is a hunger, a marrow deep, to know our heritage – to know who we are and where we came from.” Alex Haley

Kol Israel Foundation of Cleveland is pleased to provide speakers and presentations for Holocaust and genocide education. To request a speaker/presentation, please complete this form.

Holocaust Education Outreach Program: Surviving the Holocaust: Our Stories

This program involves an adult child or grandchild of a Holocaust Survivor who present their parent’s or grandparent’s story and videotaped testimony enhanced with authentic historic and person photos (about 20 min. long) into a 30-40 minute presentation. A DVD player or Internet access connected to a projection screen must be available for this program.

Presentations are best suited for grades six and above with some exceptions.

Your Contact Information:

Name of School/Group

Contact Name

First Name

Last Name

Daytime Phone

(###)

###

####

Email Address *

Location of Program *

Group will meet in:

e.g. school auditorium, other site

Does the site have A/V and Internet capabilities?

DVD

Internet Connection

Projector

Will tech support be available for the presentation?

Yes

What types of experiences in learning about the Holocaust has this group had?

Books? Films?

Are there other types of issues such as bullying, genocide, racism being addressed?

If so, what?

How long would you like the presentation to be, including Q&A?

What time would you like the speaker to present?

Hour

Minute

Second

Please list possible dates for consideration.

Is there any other information/special request you would like us to know?