Elementary School Program Request Form

Thank you for your interest in Junior Achievement. Please fill out the following information as completely as possible so that we may process your request. After we receive your information, our Program Manager will contact you.

School Name* required

Teacher Name* required

District* required

Principal* required

School Phone* required

Classroom Phone

Cell Phone

Home Phone

Planning Period

Email Address* required

You can reach me most easily by:

Gender (required for grants & funding)* required

Grade/Program (elementary)* required

Number of Students* required

Class Time* required

Semester (choice)* required

Additional Programs

Please provide the above information for each additional class request.

Which month do you want the program to start?* required

Please select all that apply. We will make every effort to have your volunteer start in your request month, but cannot guarantee.

Do you need a bilingual volunteer?

Please specify language:

Have you hosted a JA volunteer before?* required

If so, do you want the previous volunteer to return?

Name

If so, what was their name?

Home Phone

Please provide their phone number if possible.

Ethnicity (required for grants & funding)* required

If you are requesting for a volunteer to return, they must complete the Volunteer Form and return it to the JA Office.