The Gilder Lehrman Institute of American History

Thank you for your interest in the Gilder Lehrman Affiliate School Program.

Please mail this application form and all additional material to:

Gilder Lehrman Affiliate School Program
Gilder Lehrman Institute of American History
19 West 44th Street, Suite 500
New York, NY   10036

Contact Information

Title

[   ] Mr.    [   ] Ms.    [   ] Mrs.    [   ] Dr.   

First Name

 

Middle Initial

 

Last Name

 

Phone

 

Job Title

 

School Information

School / Workplace Name

 

Address 1

 

Address 2

 

City

 

State

 

Zip

 

Country

 

District

 

School Phone

 

School Website

 

School Type

 

Grade Levels of Your School (you may select more than one):

Grades K-4?

[   ] No    [   ] Yes   

Grades 5-8?

[   ] No    [   ] Yes   

Grades 9-12?

[   ] No    [   ] Yes   

Community College?

[   ] No    [   ] Yes   

Are you currently participating in a Teaching American History grant program?

[   ] No    [   ] Yes   

Please list the name of the LEA associated with your Teaching American History grant:

 

Is your school a member of the National Association of Independent Schools (NAIS)?

[   ] No    [   ] Yes   

Is your school affiliated with an archdiocese or church?

[   ] No    [   ] Yes   

Advisor

Please designate an Advisor for your Affiliate School. The Advisor will be your school's main contact with the Gilder Lehrman Institute.

Select 'Yes' if the Advisor information is the same as the Contact information.

[   ] No    [   ] Yes   

Title

 

First Name

 

Last Name

 

Phone

 

Email

 

Principal of School:

Title

 

First Name

 

Last Name

 

Phone

 

Email

 

How did you hear about the Gilder Lehrman Affiliate Schools Program?

 

If other, describe:

 

Affiliate School Plan

Please provide a brief demographic profile of your school. How many students are in each grade? What's the racial/ethnic breakdown? Is the school located in an urban, suburban or rural setting?

 

Why does your school want to become a Gilder Lehrman Affiliate School? Which activities will your teachers and students take part in? What Gilder Lehrman materials do you plan to use?