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Volunteer & Teacher Completion Statement Form
"
*
" indicates required fields
I am a(n):
*
Educator
Volunteer
Basic Information
Name
*
First
Last
Primary Email
*
School Information
School name where JA was taught
*
Classroom teacher name
*
Grade Taught
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Please select one
K-5th
6th-8th
9th-12th
Other
JA Program Taught
*
Kindergarten - JA Ourselves®
1st Grade - JA Our Families®
2nd Grade - JA Our Community®
3rd Grade - JA Our City®
4th Grade - JA Our Region®
5th Grade - JA Our Nation™
JA Career Speaker Series
JA More Than Money
JA Money in Motion Lite
JA My Journey
Other
How many classrooms received JA Ourselves?
How many lessons were completed for JA Ourselves?
How many classrooms received JA Our Families?
How many lessons were completed for JA Our Families?
How many classrooms received JA Our Community?
How many lessons were completed for JA Our Community?
How many classrooms received JA Our City?
How many lessons were completed for JA Our City?
How many classrooms received JA Our Region?
How many lessons were completed for JA Our Region?
How many classrooms received JA Our Nation?
How many lessons were completed for JA Our Nation?
How many classrooms received JA Career Speaker Series?
How many lessons were completed for JA Career Speaker Series?
How many classrooms received JA More Than Money?
How many lessons were completed for JA More Than Money?
How many classrooms received JA Money in Motion Lite?
How many lessons were completed for JA Money in Motion Lite?
How many classrooms received JA My Journey?
How many lessons were completed for JA My Journey?
How many classrooms received the JA program?
How many lessons were completed?
JA Program Taught
*
JA Economics for Success®
JA It’s My Future™
JA Career Speaker Series
JA STEM Summit
JA It's My Job
JA More Than Money
JA Money in Motion Lite
Other
How many classrooms received JA Economics for Success?
How many lessons were completed?
How many classrooms received JA It's My Future?
How many lessons were completed for JA It's My Future?
How many classrooms received JA Career Speaker Series?
How many lessons were completed for JA Career Speaker Series?
How many classrooms received JA STEM Summit?
How many lessons were completed for JA STEM Summit?
How many classrooms received JA It's My Job?
How many lessons were completed for JA It's My Job?
How many classrooms received JA More Than Money?
How many lessons were completed for JA More Than Money?
How many classrooms received JA Money in Motion Lite?
How many lessons were completed for JA Money in Motion Lite?
How many classrooms received the JA program?
How many lessons were completed?
JA Program Taught
*
JA Career Speaker Series
JA Personal Finance
JA STEM Summit
JA Be Entrepreneurial®
JA Career Success™
JA Economics®
JA Student Stock Market Challenge
JA It's My Job
Other
How many classrooms received the JA Career Speaker Series?
How many lessons were completed for the JA Career Speaker Series?
How many classrooms received JA Personal Finance?
How many lessons were completed for JA Personal Finance?
How many classrooms received JA STEM Summit?
How many lessons were completed for JA STEM Summit?
How many classrooms received JA Be Entrepreneurial?
How many lessons were completed for JA Be Entrepreneurial?
How many classrooms received JA Career Success?
How many lessons were completed for JA Career Success?
How many classrooms received JA Economics?
How many lessons were completed for JA Economics?
How many classrooms received JA Student Stock Market Challenge?
How many lessons were completed for JA Student Stock Market Challenge?
How many classrooms received JA It's My Job?
How many lessons were completed for JA It's My Job?
How many classrooms received the JA program?
How many lessons were completed?
I certify that I completed the above program(s) in accordance with JA USA Implementation standards.
*
Yes
No
Educator Feedback
I would recommend JA programs to another educator
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4 - Strongly Agree
3 - Agree
2 - Disagree
1 - Strongly Disagree
N/A
Please explain why you provided that rating
My JA volunteer was adequately prepared
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4 - Strongly Agree
3 - Agree
2 - Disagree
1 - Strongly Disagree
N/A
Please explain why you provided that rating
JA staff was supportive
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4 - Strongly Agree
3 - Agree
2 - Disagree
1 - Strongly Disagree
N/A
Please explain why you provided that rating
My JA volunteer successfully established a rapport with my students
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4 - Strongly Agree
3 - Agree
2 - Disagree
1 - Strongly Disagree
N/A
Please explain why you provided that rating
The activities of the JA program were effective in engaging the students
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4 - Strongly Agree
3 - Agree
2 - Disagree
1 - Strongly Disagree
N/A
Please explain why you provided that rating
Volunteer Feedback
I would recommend volunteering with JA to a friend or co-worker
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4 - Strongly Agree
3 - Agree
2 - Disagree
1 - Strongly Disagree
N/A
Please explain why you provided that rating
My JA staff contact was helpful and supportive (if needed) throughout my experience
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4 - Strongly Agree
3 - Agree
2 - Disagree
1 - Strongly Disagree
N/A
Please explain why you provided that rating
I would be interested in volunteering again
*
Yes
No
Please explain why you provided that rating
I had the training and tools to prepare for teaching my JA program
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4 - Strongly Agree
3 - Agree
2 - Disagree
1 - Strongly Disagree
N/A
Please explain why you provided that rating
Volunteering for Junior Achievement has strengthened my professional skillset (ex: communication, time management, public speaking, etc.).
*
4 - Strongly Agree
3 - Agree
2 - Disagree
1 - Strongly Disagree
N/A
Please explain why you provided that rating
The classroom teacher provided me with enough support
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4 - Strongly Agree
3 - Agree
2 - Disagree
1 - Strongly Disagree
N/A
Please explain why you provided that rating
The teacher remained in the classroom while the students were present.
*
Yes
No
Optional: Additional Feedback
Please provide any feedback or recommendations for the future:
Please share a short story that illustrates the impact of JA programs on the students so that we can share it with others – a funny moment, an anecdote, or a light-bulb moment:
Consent
Yes, I’d like to receive promotional text messages from Junior Achievement of Arizona. Message and data rates may apply. Message frequency varies. Reply STOP to unsubscribe or HELP for help. See our Privacy Policy and Terms of Service. Consent is optional and is not required to submit this form.
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