JA of Central Virginia - How It Works

JA Class Request Form

If you would like to have JA programs in your classroom, please fill out the form below and submit it. After we receive your information, our Education Managers will contact you. Please fill out one form for each class request.

Teacher's Name

First:* MI: Last:* Suffix:

Nickname:

Teacher's Home Contact Information

Home Phone:*

Home E-mail:*

School Information

School Name:*

Street:*

City:* State:* ZIP:*

School Phone:* Fax:

Teacher's School E-mail:

Which contact info do you prefer we use?

Class Information*

If you selected an Elementary grade above, please disregard the below Middle and High School programs selections. Elementary grade programs are based on grade levels. If you selected a Middle or High School grade above, please indicate which JA program you would like in your classroom by selecting from the list below.

Middle Grade Programs:

High School Programs:

During what semester would you like to have a JA class?

Number of Students:

* Indicates Required Fields