It’s great to hear you’re interested
in getting involved with the
Day of Silence®!

 
• Ally Week - October
• TransAction!
• Dr. MLK Jr. Organizing Weekend
• Day of Silence
 
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(Gay, Lesbian and Straight Education Network)		  
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This form is for students and teachers working to organize the Day of Silence in their college or university.

To register, simply fill out the form below as completely as possible. The Day of Silence does not sell or trade your personal information, and only shares with others with your permission. Please review our Privacy Policy for more information.
A. Individual Contact Information - Please provide a mailing address, phone number and email where it is safe for you to receive Day of Silence and USSA materials.
Name:
Mailing Address:




City, State & Zip:




Phone (+ area code):
Email:
College Graduation:
Directory - May we share your information with others organizing
the Day of Silence in your local area?
 
B. School & Group Information
School Name:
Which best describes your role?

Group's Name (i.e.; Queer Union, Amnesty, Student Union, etc):


About how many members does your group have?

Do you want your school name listed in the online directory of participating schools?

 
C. Organizing Information
  Were you active in a GSA during high school?
   
  What year did you first participate in the Day of Silence?
   
  Are willing to speak to the media about your participation in Day of Silence?
   
D. Other - Please use the space provided to answer the following questions. Please limit your comments to 50 words or less.
What, if any, activities are you, or your group, planning around the Day of Silence?


Are there any questions/comments you’d like to share?


Please share how you heard about the Day of Silence?