Teacher Schedule: Middle / High School

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Teacher Schedule: Middle / High School
Please return this form via email or fax
P A R T 1 :
T E A C H E R / C L A S S I N F O R M A T I O N
P A R T
3 :
J A
C L A S S
I N F O R M A T I O N
P l e a s e u s e p e n i f c o m p l e t i n g b y h a n d .
L e n g t h o f
M i n i m u m
G R A D E
J A P R O G R A M
E a c h C l a s s
# o f V i s i t s
7
G l o b a l M a r k e t p l a c e ( k i t )
5 0 m i n
6
Teacher:
7
E c o n o m i c s F o r S u c c e s s
5 0 m i n
6
( P l e a s e i n c l u d e f i r s t n a m e a n d l a s t n a m e )
8
I t ’ s M y B u s i n e s s
5 0 m i n
6
School:
8
I t ’ s M y F u t u r e
5 0 m i n
7
Grade/Program:
# of students:
P e r s o n a l F i n a n c e
5 0 m i n
7
9
CLASS 1
CLASS 2
CLASS 3
Is this your first year of JA at this grade level?
Yes
No
Period #:
Period #:
Period #:
Gender (M / F )
Ethnicity:
Start Time:
Start Time:
Start Time:
End Time:
End Time:
End Time:
Home Phone:
# in Class:
# in Class:
# in Class:
Work Phone:
CLASS 4
CLASS 5
CLASS 6
Email:
Period #:
Period #:
Period #:
Best times to reach you:
Start Time:
Start Time:
Start Time:
End Time:
End Time:
End Time:
D o y o u r c l a s s e s . . .
# in Class:
# in Class:
# in Class:
m e e t a t t h e s a m e t i m e e v e r y d a y ?
yes
no
D a y s Y o u P r e f e r F o r Y o u r J A P r o g r a m
m e e t a t t h e s a m e t i m e e v e r y O T H E R d a y ?
yes
no
ANY DAY
Mon
Tues
Wed
Thurs
Fri
P l e a s e d e s c r i b e a n y s c h e d u l e v a r i a t i o n s b e l o w .
F r e q u e n c y o f V i s i t s
My volunteer may come once weekly for 6 weeks.
Yes
No
P A R T 2 :
V O L U N T E E R P R E F E R E N C E S
My volunteer may come twice weekly for 3 weeks.
Yes
No
My volunteer may come daily for 6 consecutive days.
Yes
No
The most successful and dependable volunteers generally
come from teacher referrals. Please list potential role
My volunteer may teach multiple sessions in one day.
Yes
No
models that could serve as your JA volunteer(s) below.
You
might
consider
parents
of
your
students,
past
O T H E R I N F O R M A T I O N
volunteers, business professionals, relatives, etc.
(please circle your wave preference if any)
Fall
Wi nter
S pring
PLEASE RANK ALL NOMI NEES IN ORD ER OF PREFERENCE
(Sept 28)
(Jan 25 )
( April 11-April 22)
(1 = First choice for volunteer, 2 = Second choice, etc.)
RANK
Volunteer Name
Phone and / or Email Address
J U N I O R A C H I E V E M E N T O F F I C E U S E O N L Y
Name / Title:
Organization:
Address:
Work Phone:
Home Phone:
May we use a parent of a student as your volunteer?
yes
no
Fax Number:
Cell Phone:
Email:
Would your student teacher like to be your JA volunteer?
yes
no
( I f y e s , p l e a s e l i s t n a m e , c o l l e g e , a n d p h o n e / e m a i l b e l o w )
Child in this school?
In this class?
yes
no
yes
no
J A E X P E R I E N C E :
New to JA
New to Grade
Veteran
J A D A Y / T I M E :
T R A I N I N G I N F O :
P H :
5 7 4 - 2 9 3 - 4 5 3 0
F A X :
5 7 4 - 8 3 0 - 1 1 8 6
t y l e r . j a c k s o n @ j a . o r g / m e n e s s a h . n e l o n @ j a . o r g

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