JA Inspire School/Organization Registration Form

Are you registering a school or another student group?*

School
Other organization

School Name*

Organization Name*

School Phone Number*

Organization Phone Number*

School Address*

Street Address City State / Province / Region ZIP / Postal Code

Organization Address*

Street Address City State / Province / Region ZIP / Postal Code

Will more than one class at the school participate in JA Inspire?*

Yes, more than one class will participate this year
No

School Coordinator Name

If more than one class is participating, who will serve as JA's main coordinator? If just one class, please jump to Teacher section.

First Last

Coordinator Name*

First Last

Coordinator Phone*

Coordinator Email*

Principal Name*

First Last

Principal Phone

Principal Email

Teacher #1

**For each teacher registering, please list their name, email, grade, and number of students participating.**

Name Email Grade # of Students

How many students will be participating in JA Inspire and in what grades?

Grade # of Students

Teacher #2

Name Email Grade # of Students

Teacher #3

Name Email Grade # of Students

Teacher #4

Name Email Grade # of Students

Teacher #5

Name Email Grade # of Students

Teacher #6

Name Email Grade # of Students

Teacher #7

Name Email Grade # of Students

Teacher #8

Street Address Address Line 2 City State / Province / Region

Teacher #9

Street Address Address Line 2 City State / Province / Region

Teacher #10

Street Address Address Line 2 City State / Province / Region

Teacher #11

Street Address Address Line 2 City State / Province / Region

Teacher #12

Name Email Grade # of Students

Student Logins*

For your school's student logins, would you prefer to use students' school email addresses or generic logins set by JA?

We'll use our students' school emails - I will submit the login template to JA
Please create generic logins for my students

I plan to have my students participate in the on-demand JA Inspire program (check all that apply):*

Select All
Fall Semester 2021 – Quarter 1
Fall Semester 2021 – Quarter 2
Spring Semester 2022 – Quarter 3
Spring Semester 2022 – Quarter 4
Other

If you selected "Other ", please specify:

Additional Comments

Consent*

Junior Achievement Responsibilities:
• Junior Achievement offers its curriculum to individual classrooms/organizations and will provide materials free of charge.
• Junior Achievement will train teachers/facilitators as needed and will provide support throughout the JA program.

Principal Responsibilities:
• Principal/coordinator will allow JA staff to speak at a faculty meeting to train and review curriculum with teachers/facilitators.
• Principals/coordinator agree that JA staff can communicate directly with teachers/facilitators to coordinate programs.
• Principal/coordinator will agree to allow students to attend the JA Inspire Virtual Expo online interacting with the virtual vendors in accordance with JA USA COPPA Agreement (attached).
• Principal/coordinator reviews and agrees with teacher/coordinator responsibilities listed below.

Coordinator Responsibilities:
• Coordinator agrees to help coordinate teacher/facilitator training.
• Coordinator assists with scheduling JA Inspire preparatory programming and event attendance.
• Coordinator assists with collection of pre- and post-student surveys from teachers/facilitators.
• Coordinator works with JA staff to determine the number of students participating in JA Inspire Virtual event.

Teacher/Facilitator Responsibilities:
• Teachers/facilitators will work with JA staff to ensure that all sessions of JA Inspire are completed.
• Teachers/facilitators will reserve class time for students to actively engage in the JA Inspire Virtual Career Fair.
• Teachers/facilitators will help students explore the JA Inspire Virtual Career Fair and utilize student digital backpack and Student Digital Career Book, during and after their initial JA Inspire Virtual visit.
• Teachers/facilitators will ensure that students complete the pre- and post-surveys and return them to JA Staff.

By checking this box, I agree to the following items:

Educator/Facilitator, Coordinator, or Principal Signature*

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JA Inspire School/Organization Registration