Clone of 2025- 2026 Teacher - Class Request Form

1
Are you requesting JA BizTown or JA Finance Park?* This field is required.This class request form is not used for JA BizTown or JA Finance Park. If you select 'yes' you will be redirected to the correct links.
YESNO
2
Contact Information (Required)* This field is required.
Please Select
Please Select
Mr.
Ms.
Mrs.
Dr.
Admiral
Captain
Chief
Cmdr.
Col.
General
Lt
Lt. Col.
Sergeant
Prof.
Title
First Name
Last Name
Email (example@example.com)
3
Contact Information (Optional)
Personal Email
Cell Phone
Planning Time/Best Time to Contact
4
Are you requesting Junior Achievement on behalf of multiple teachers OR your grade-level team?* This field is required.
YESNO
5
Contact Information (Additional Teachers)
First Name
Last Name
Email Address
Teacher 1
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Teacher 2
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Teacher 3
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Teacher 4
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Teacher 1
Teacher 2
Teacher 3
Teacher 4
First Name
Row 0, Column 0
Last Name
Row 0, Column 1
Email Address
Row 0, Column 2
First Name
Row 1, Column 0
Last Name
Row 1, Column 1
Email Address
Row 1, Column 2
First Name
Row 2, Column 0
Last Name
Row 2, Column 1
Email Address
Row 2, Column 2
First Name
Row 3, Column 0
Last Name
Row 3, Column 1
Email Address
Row 3, Column 2
1 of 4
6
School Information* This field is required.
School Name
Please Select
Please Select
Anderson
Bath
Bourbon
Boyd
Boyle
Breathitt
Cabel, WV
Carter
Clark
Estill
Fayette
Franklin
Garrard
Greenup
Harrison
Jackson
Jessamine
Kanawha, WV
Knox
Laurel
Lawrence
Lee
Lincoln
Lincoln, WV
Madison
Martin
Mason, WV
McCreary
Menifee
Mercer
Montgomery
Nicholas
Owsley
Pike
Powell
Pulaski
Putman, WV
Raleigh, WV
Rockcastle
Scott
Wayne, WV
Whitley
Wolfe
Woodford
Other
County Name
School Phone Number (Optional)
7
Participating Student Details* This field is required.
Please Select
Please Select
Elementary
Middle
High
School Level of Participating Students
Please Select
Please Select
K
1
2
3
4
5
6
7
8
9
10
11
12
Grade Level of Participating Students
Total Number of Participating Students
Total Number of Participating Classes
8
Elementary Program Requested:
Please Select
Please Select
(K) JA Ourselves
(1) JA Our Families
(2) JA Our Community
(3) JA Our City
(4) JA Our Region
(5) JA Our Nation
(K-5) JA Career Speaker Series
Other
Unsure
9
Middle School Program Requested:
Please Select
Please Select
(6-8) JA Career Speaker Series
(6-8) JA It's My Future
Other
Unsure
10
High School Program Requested:
Please Select
Please Select
JA Career Success
JA High School Heroes
JA It's My Job
JA Personal Success
JA Stock Market Challenge
JA Teacher-Led Semester Long Courses
Other
Unsure
11
If "other" or "unsure" please elaborate here:
12
Scheduling Preferences
Please Select
Please Select
Fall
Spring
No Preference
Semester Preference
Please Select
Please Select
Traditional (JA class taught once weekly)
Custom (JA class taught on a custom schedule)
JA in a Day (full JA program delivered in one day)
No Preference
Delivery Method Preference
Additional Scheduling Preferences
13
Do you have a volunteer in mind to teach your class?
YESNO
14
Requested Volunteer Information
Volunteer First Name
Volunteer Last Name
Volunteer Email Address
Please Select
Please Select
Yes
No
Has this volunteer already agreed to teach your class?
15
Have you had JA before, either as a student or as a teacher?
YESNO
16
How did you learn about Junior Achievement?
Please Select
Please Select
Recommended by a friend or colleague
Social Media
Search engine (Google, Yahoo, etc.)
Advertisement
Other
17
Thank you for completing the Junior Achievement 2026- 2027 Class Request Form. You will recieve a completed copy of this form in your email inbox. For more information call our office at 859.219.2423 or visit our website at https://bluegrass.ja.org.
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