My School wants to Participate

If you have a classroom, headstart, or daycare program that would like to participate in JA complete the form below.

PLEASE COMPLETE ONE FORM FOR EACH CLASS.

Personal Information:	School Information:	Semester:
Name:	School Name:	Fall
Home Address:	School District:	Spring
City, State:	Address:	Grade Level:
Zip:	City, State:	Elementary (K-5)
Phone:	Phone:	Middle Grades (6-8)
Alternate Number:	Email:	High School (9-12)
		Number of Classes:
		Number of Students:
		Class Times:  Please complete with time and not period number.

Preferred Method of Correspondence: Home Address: School Address: Email
In JA as Student?: Yes: No
Years volunteering for JA: 
Birth Month Only: 
Gender: Male: Female
Ethnicity
 <-- Make Selection -->BlackWhiteHispanicAmerican IndianAsianHawaiian/Pacific Islander

Program Information:
Please indicate which programs you are interested in teaching.  You may select more than one.

Junior Achievement is a partnership between the business community, educators and volunteers all working together to inspire young people to dream big and reach their potential.  Along with your time and talent, please consider an investment of your treasure by making a donation to Junior Achievement.

I would like to make a donation to Junior Achievement:
I will be mailing a donation for $
Please invoice me for my personal gift of $ in month: 
Please send me information on the special events taking place in my area

For more information about our programs, please contact our Director of Education Kelli Ruiz, at 814-266-2125 Ext. 197 or email: kruiz@jawesternpa.org