20/21 JA Company Program Pre-Program Survey (EI)

Tell Us about You

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1. What are the first 3 letters of your last name?

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2. When is your birthday?

	Month	Date
Month/Date	Month/Date Month menu	Month/Date Date menu

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3. What is your teacher's last name?

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4. What grade are you in?

9th

10th

11th

12th

Other (please specify)

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5. What school do you attend?

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6. How many times have you participated in JA In the past?

This is my first time

1 time

2 times

3 times

4 times

5 or more times