2010-2011 JA Teacher Class Request Form
Required Required Question(s)

Thank you for your interest in providing Junior Achievement to your classroom. 

We ask that you please complete the following form for each teacher and classroom you would like to request a program for.  If you have any questions, please contact the JA office at 413-747-7670 or at jawesternma@jawm.org.

 
Required 1.

Please provide your name and school contact information.
First Name:
Last Name:
Company Name:
Work Phone:
Email Address:
emailaddress@xyz.com
City:
State/Province
(US/Canada):

Required 2.

Best Form of Contact
Since teachers are in class all day, often without access to take phone calls, we ask that you please provide the best form of contact for a JA staff member or volunteer to reach you (i.e. email, cell phone, and/or home phone).  This information will be used to coordinate a volunteer coming into your classroom, or to clarify any outstanding questions regarding the JA class request.
 

  • 350 characters left.
Required 3.

The grade level of the students will be:
Check all that apply
K
1
2
3
4
5
6
7
8
9
10
11
12
  • Comment:

  • 500 characters left.
Required 4.

Number of students in the classroom:
 

  • 50 characters left.
5.

Middle & High School Teachers
Please select the JA program you would like to offer:
JA America Works (Middle School Program)
JA Global Marketplace (Middle School Program)
Our Nation (Middle School Program)
JA It's My Business (Middle School Program)
JA Economics for Success (Middle or High School Program)
JA Company Program (Middle or High School Program)
JA Banks in Action (High School Program)
JA Bank on It (High School Program)
JA Be Entrepreneurial (High School Program)
JA Business Ethics (High School Program)
JA Be Entrepreneurial (High School Program)
JA Careers with a Purpose (High School Program)
JA Economics (High School Program)
JA Exploring Economics (High School Program)
JA Success Skills (High School Program)
JA Titan (High School Program)
JA Personal Finance (High School Program)
Required 6.

Please check the seasons when you COULD offer a JA program.
Check all that apply
ANYTIME (October - June)
Fall (October - December)
Winter (January - March)
Spring (April - June)
  • Comment:

  • 500 characters left.
7.

Please select the days of the week when you COULD offer the program.
Check all that apply
Monday
Tuesday
Wednesday
Thursday
Friday
  • Comment:

  • 500 characters left.
8.

Please indicate the time of day you would like to offer the program.
(i.e. between 11am - 12pm, or after 1pm)
 

  • 50 characters left.
9.

Junior Achievement is a volunteer-driven, non-profit organization. 
Although we will try hard to find a volunteer to work with you and your classroom, without a volunteer we will not be able to provide you with the program. 
If you have any prospective volunteers, we will be happy to contact them and provide them with all of the materials and training needed.  Please provide their name and contact information here. 
(If this volunteer provides JA to your classroom, you will receive a JA prize-pack and be entered into a raffle contest to be drawn at the conclusion of the school year.)
 

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Thank you again for requesting Junior Achievement to be a part of your school curriculum. 

A JA staff member or volunteer will contact you once a volunteer has been found to work with you and your classroom.  If you have any questions, please contact Rebecca MacGregor, Program Manager, at 413-747-7670 or at rmacgregor@jawm.org.