Teacher Class Request

Date:

For Funding/Grant purposes, please provide YOUR race/ethnic origin:
African American Alaskan Native American Indian Asian
Caucasian Hawaiian Hispanic Multi-racial

Title: Mr. Mrs. Ms.

First Name: Last Name:

School: Grade: Room #

Class Subject:

School Phone: School Fax:

Email: Planning Period:

Home Address: City: Zip:

Home Phone: Cell Phone:

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2007-2008 Requirements:
All Classes must start early enough in the fall or spring semesters to conclude no later than December 10th (for fall) and May 15th (for spring). Many of our volunteers are from the business community, so we encourage you and your volunteer to work together to create a flexible schedule that benefits both of you. This will allow for a variation of day(s) per week and also class times. However, all required lessons must be completed.

Semester: Fall: Spring: Both (Available for middle and high school only)

Tentative Start date: (Elem: 5 wks; MS/HS: 6-8 wks)

Are you a new teacher: Yes No

Have you had JA Teacher Training: Yes No

Will there be flexibility with your volunteer when scheduling JA? Yes No

Do you have a JA volunteer request or can you recommend someone? If so, please provide name and telephone number:

**Please note** If you are departmentalized, please indicate the total number of classes that you teach because you will have a separate volunteer for each class.

Total Classes: Total Volunteers:

Class Period 1
Class Time: Student Count:
Homeroom Teacher (if applicable):

Class Period 2
Class Time: Student Count:
Homeroom Teacher (if applicable):

Class Period 3:
Class Time: Student Count::
Homeroom Teacher (if applicable):

Class Period 4:
Class Time: Student Count:
Homeroom Teacher (if applicable):

Class Period 5:
Class Time: Student Count:
Homeroom Teacher (if applicable):

Class Period 6:
Class Time: Student Count:
Homeroom Teacher (if applicable):

Class Period 7:
Class Time: Student Count:
Homeroom Teacher (if applicable):

Class Period 8:
Class Time: Student Count:
Homeroom Teacher (if applicable):

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Teacher Roles & Responsibilities

~ Call your volunteer within two weeks of receiving your assignment and be
responsive to their attempts to contact you.
~ Remain in your classroom at all times during the JA volunteer visits.
~ Our volunteers are not licensed to be in a classroom alone.
~ Our volunteers may need assistance with discussions or activities.
~ Our JA volunteers rely on you to handle classroom mangement issues.
~ Notify your JA Volunteer if you are planning to have a substitute or if plans for the
   day change.
~ Notify the JA office (677-3557) immediately of any issues and/or changes that may
   hinder the completion of the program in your classroom.
~ Please thank your volunteer(s) and make them feel special! (Ex: Invite them back
   to volunteer for you again and/or create a way for your students to thank them as
   well i.e., JA banner, JA certificate, letter or card signed by the students, etc).

I have read and agree with the Teacher Roles & Responsibilities. Yes: No