Launch Lesson REQUEST FORM

JA Launch Lesson REQUEST FORM

Thank you for your interest in hosting a JA Launch Lesson. Please fill out this form so we can make sure we bring together speakers that will appeal to your students! Questions? Please contact Jane Taff, Program Manager, 916.480.2770 x1013
School/Organization Name*
Name*

First NameLast Name
Best Phone Number to reach you during the day:*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Approximate Total # of Students*
Grades Attending*

6th Grade7th Grade8th Grade9th Grade10th Grade11th Grade12th Grade
Please choose up to 4 Career Clusters for Speakers:*

Agriculture, Food & Natural ResourcesArchitecture & ConstructionArts, A/V Technology & CommunicationsBusiness, Management & AdministrationEducation & TrainingFinanceGovernment & Public AdministrationHealth ScienceHospitality & TourismHuman ServicesInformation TechnologyLaw, Public Safety & SecurityManufacturingMarketing, Sales & ServiceScience, Technology, Engineering & MathematicsTransportation, Distribution & LogisticsOther
I would like to have a Speaker:

come to my Classroom In-Personscheduled to visit VirtuallyEither In-Person or Virtually
I am requesting the following length for my workshop:*

20-30 Minutes40-50 MinutesOther
Questions or any other information you would like to share to help us choose a speaker that would engage your students:
Please choose your top 3 dates and times IN NOVEMBER that you prefer to host a speaker:
My FIRST CHOICE of date and time for the speaker is:*

MonthDayYear
Date
Hour MinutesAM/PM Option
My SECOND CHOICE of date and time for the speaker is:*

MonthDayYear
Date
Hour MinutesAM/PM Option
My THIRD CHOICE of date and time for the speaker is:

MonthDayYear
Date
Hour MinutesAM/PM Option
Should be Empty:

JA Launch Lesson REQUEST FORM

Please choose your top 3 dates and times IN NOVEMBER that you prefer to host a speaker: