Exit this survey 

2012 LCPA-JA Day Volunteer Form

 

*

1. Please provide your contact information. Your area Junior Achievement Program Manager will contact you regarding training/delivery of classroom materials.

Please provide your contact information. Your area Junior Achievement Program Manager will contact you regarding training/delivery of classroom materials.   Name:
Company:
Address:
Address 2:
City/Town:
State:	-- select state --AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming
ZIP:
Email Address:
Phone Number:

2. Please select the school at which you want to volunteer:

Please select the school at which you want to volunteer:   Baton Rouge: The Dufroc School - April 24 Baton Rouge: Greenbrier Elementary - April 25 Baton Rouge: Riveroaks Park Elementary - April 25 Baton Rouge: Children’s Charter Elementary - May 15 Lafayette: Prairie Elementary - April 23 - date change! Houma: Coteau-Bayou Blue Elementary - May 1 New Orleans: Moton Charter School - April 25 New Orleans: Hynes Elementary - May 1 Jefferson: Marie Riviere Elementary - May 1 Northshore: Mandeville Middle - February 8 Shreveport: Central Elementary - April 27

3. Are you a CPA?

Are you a CPA?   Yes No

4. Have you previously participated in LCPA-JA Day?

Have you previously participated in LCPA-JA Day?   Yes No

5. If you haven't participated in LCPA-JA Day, have you ever volunteered for JA before?

If you haven't participated in LCPA-JA Day, have you ever volunteered for JA before?   Yes No

6. If you have volunteered for JA before, either through LCPA-JA Day or any other JA program, please indicate the grade(s) for which you have presented:

If you have volunteered for JA before, either through LCPA-JA Day or any other JA program, please indicate the grade(s) for which you have presented:   Kindergarten 1st grade 2nd grade

3rd grade 4th grade 5th grade

6th grade Other

7. Do you have a preference as to which grade you are assigned? (Keep in mind that JA Program Managers do their best to meet volunteer preferences, but may need to assign you to an alternate grade if needed.)

Do you have a preference as to which grade you are assigned? (Keep in mind that JA Program Managers do their best to meet volunteer preferences, but may need to assign you to an alternate grade if needed.)

8. Gender:

Gender:   Male Female

9. Ethnicity:

Ethnicity:   African American American Indian

Asian Caucasian

Hispanic Multi-racial

10. Would you like to be paired with a co-volunteer?

Would you like to be paired with a co-volunteer?   Yes No

11. If you would like to be paired with another volunteer, please specify name of other volunteer if known:

If you would like to be paired with another volunteer, please specify name of other volunteer if known:

*

12. By submitting this volunteer form, I understand that if I have not previously taken a JA training course that I will have to do so prior to my volunteer experience. I realize that I am committing to attending on the date/event indicated and know that my participation is counted on by the school and its students.

By submitting this volunteer form, I understand that if I have not previously taken a JA training course that I will have to do so prior to my volunteer experience. I realize that I am committing to attending on the date/event indicated and know that my participation is counted on by the school and its students.   I understand