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* 1. Volunteer Name:

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* 2. Email:

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* 3. School or Site Name:

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* 4. Teacher's name:

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* 5. # of Students (average # if forgotten):

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* 6. Program taught:

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* 7. # of Lessons taught:

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* 8. Class completion date:

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* 9. How many years have you volunteered?

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* 10. Would you be willing to volunteer again?  If so, please note any age/school/teacher preferences.

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* 11. Would you recommend this experience to colleagues or friends?

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* 12. What was the highlight of your JA experience? 

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* 13. How can we improve your JA experience? (i.e., training, materials, teacher, age group)

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* 14. Please rate the overall effectiveness of the program

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* 15. Please include any additional comments or feedback.

Please email Jackie Worley (jworley@jaark.org) or Tonya Villines (tvillines@jaark.org) with any questions or concerns.

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