Personal Information

   
(Mr./Ms.):
Full Name: *
Home Address:*
City:*
State:*
Zip:*
Home Phone:*   (area code) xxx-xxxx
Cell Phone:   (area code) xxx-xxxx
E-Mail Address:*
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.
Due to requirements for certain grants and funding, we need the following information:
Gender: *                Ethnicity:*   

Business/Employment Information

 
Company Name (Full):
Position:
Business Address:
City:
State:
Zip:
Business Phone:    (area code) xxx-xxxx
Business Email

Your Preferences

   
Have you taught a Junior Achievement class in CT in the last 5 years?*     
List geographic location or school preferences:  
Grade level preference

 

 

VOLUNTEER CONDUCT STANDARDS


*(required)

   
Please read the Volunteer Conduct Standards below. All volunteers must agree and abide by these standards.  Please select the "I Agree" button to complete your registration.
 

 
                I agree to the above terms