WordPressVersion-JA Verification Form

Full Name *

First Name Last Name

E-mail *

Are you the classroom teacher or JA volunteer? *

Choose One.

Please tell us how you engaged your JA volunteer *

I used the JA recorded volunteer videos. I had a LIVE virtual volunteer. I did not have a JA volunteer. Not applicable, I am the JA volunteer.

If you had a LIVE virtual volunteer, please tell us their name:

JA Program Completed *

School Name *

Grade *

Number of Students in Class *

If multiple grade levels were listed above, specify the number of students per grade here.

Completion Date *

By selecting Agree, I verify the required number of lessons for the above program were taught and that the number of students recorded above is accurate. *

Agree

I would like to sign up for next year.

Yes No Not Sure

If you listed 'no' or 'not sure' please indicate why here:

We'd love your feedback! Please share any comments that you may have.

May we share your comments and name for marketing materials to promote JA?

Yes No Please share my comments, but I'd prefer to remain anonymous

Enter the message as it's shown *