Application - Madison Wisconsin Institutes for the Healing of Racism, Inc. - Waiting List Space Only

We currently have a waiting list for the Spring 2020 series. Please enter your information below so we can notify you if a spot opens up.


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First Name *
Enter your legal name, nickname, or preferred name
Last Name *
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Email Address *
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Primary Phone Number *
Enter your primary phone number, including area code (e.g., 608-466-2853)
Alternate Phone Number
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Age *
Enter your age using only numbers (you must be 16 or older to participate)
Have you taken the Institutes before?
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Ethnicity *
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Are there any unique needs that you may have that we should be aware of to help you participate? *
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