Junior Achievement Middle School Program Request
* Required fieldsTeacher Name* School* District*
Principal School Phone*
Email* Classroom Phone
Planning Time Cell Phone Home Phone
You can reach me most easily by: Email School Phone Cell Phone Home Phone
Due to requirements for certain grants and funding, we need the following information:
Gender* Male Female Ethnicity* <-- Make Selection -->African AmericanAlaskan NativeAmerican IndianAsianCaucasianHispanicHawaiianMulti-Racial
Middle School Programs
# ofStudents
JA Program
Course Title
Period
Class Start Time
Class End Time
Fall or Spring
Full Year Class?
Grade level and Comments
<-- Make Selection -->JA Global MarketplaceJA Economics for SuccessJA America Works
In an effort to better facilitate scheduling, please indicate below which month you would like your JA class to start. (Middle School programs are 6 sessions.) We will make every effort to have your volunteer start in your requested month, but we cannot guarantee. Please select all that apply: September October November January February March April
Is this your first time to host a JA volunteer? Yes No
Do you have someone in mind to volunteer for your class?
If so, please put their contact information here. Volunteer Name Volunteer Phone #
Volunteer Email Is this person a former JA Volunteer? Yes No
NOTE: Volunteers must complete the Volunteer Form.
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