Volunteer Information Form
First Name: MI: Last Name:
Company (if applicable):
Job Title (if applicable):
We would like to thank your supervisor for supporting your volunteerism.
Immediate Supervisor:
Supervisor Title:
Phone:
Please provide your work contact information below.
Address:
City: State: Zip:
Phone: Fax: Email:
Please provide your home contact information below.
City: State: Zip :
Where would you prefer to receive Junior Achievement of Central Pennsylvania information?
Home Work
Please select the grade levels/programs you are interested in instructing.
Elementary School Programs (Grades K-6)
Ourselves (K)
Our Families (1st Grade)
Our Community (2nd Grade)
Our City (3rd Grade)
Our Region (4th Grade)
Our Nation (5th Grade)
JA After-school - JA Dollars & $ense* (3th, 4th, & 5th Grades)
Capstone Experience - JA BizTown Finance Park (5th & 6th Grades)
* After-school programs may be presented as an in-school or after-school program.
Middle School Programs (Grades 6-9)
JA Global Marketplace
JA Economics for Success
JA America Works
JA BizKid$ (ages 9 - 14)
JA After-school - JA It's My Business*
Capstone Experience - JA Finance Park
JA Economics
JA Titan
JA Banks in Action
JA Success Skills
JA Careers with a Purpose
JA Business Ethics
The NEFE High School Financial Planning Program
JA After-school - JA Company Program*
Capstone Experience - JA Job Shadow
Would you be interested in the following? (Please check all that apply.)
Teaching an elementary program for an entire school day (Make a Difference Day or "MAD" Day)
Teaching a special needs class
Teaching after-school programs (3:00 PM - 7:00 PM)
Teaching JA Programs in Spanish
Teaching at risk students
Please choose the counties where you would be able to volunteer:
Dauphin Juniata Lancaster Lebanon Mifflin
Northumberland Schuylkill Snyder Union
If you have a preference to teach in a specific school or with a specific teacher, please fill out the information below:
School Name: Grade: Teacher:
Fall Spring Both
How many years have you been a classroom volunteer?
Equal Opportunity Information
Ethnicity (Please check all that apply.)
African American American Indian Asian American Caucasian
Hispanic Hawaiian Alaskan Native Other
Gender (Please select one):Female Male