Junior Achievement: Hampton Roads

Program Request Form

*Demographic information collected by JA is used for statistical purposes only. It is not used for individuals, but used only in aggregate form. JA is a non-profit organization that applies for grants and funding from various entities.

In these applications, we need to provide statistical information to demonstrate that JA reflects the diversity of the communities we serve. We appreciate your assistance in ensuring JA's continued service to our children.

Contact Information

First Name:			Personal Email Address:
Last Name:			Work Email Address:
JA Status:
Ethnic Origin:			Gender:
Grade Taught:			Title:

School Name:
School Phone:	*please include your extension if applicable
School Fax:

Home Address:	*this information is for Thank You Letters and auditing purposes
Home City:
Home State:
Home Zip:
Home Phone:
Cell Phone:

For scheduling purposes, may we share your personal phone number with your trained JA Volunteer?

Preferences

Your Requested Grade Level Programs:	K-Ourselves 1-Our Families 2-Our Community 3-Our City
(check all that apply)	4-Our Region 5-Our Nation More Than Money
	6-8 America Works 6-8 It's My Business
	6-8 Economics for Success 6-8 Global Marketplace
	8-12 Success Skills 9-12 Business Ethics
	9-12 Careers with a Purpose 9-12 Company Program (intensive)
	9-12 Exploring Economics 9-12 Banks in Action
	9-12 Be Entrepreneurial 9-12 Personal Finance (formerly known as NEFE)
	9-12 Titan (virtual) 9- 12Capitalism with Conscience (1-hour Spring discussion)
Semester(s):	Fall Spring
Start Date/Time:
Preferred JA Schedule: (Elementary ONLY)

Preferred Volunteer: *include contact information if not a previous JA Volunteer
Planning period times:
Comments/Notes: *please indicate if you are scheduling for a single classroom or if you are scheduling for your entire grade-level

As a JA Teacher, I agree to:

Call my volunteer and be responsive to their attempts to contact me.

Exchange contact information, such as phone numbers and email addresses

Schedule dates/times for each classroom visit

Discuss school rules

Schedule an observation visit if needed

Remain in the classroom during volunteer presentations.

The volunteer is not licensed to be in a classroom alone

The volunteer may need your assistance with the discussion or materials

The volunteer will need your help to manage the classroom

Notify the volunteer and JA office of any changes that may hinder the completion of the program, such as vacation days or if you are planning to have a substitute.

Thank the volunteer and make them feel special.

Create a way for your students to thank them
Ask them back to volunteer for you again

Upon the completion of your JA program, return the Program Verification Form to the JA office via fax, web, or email.

I have read and understand the above agreement