banner photo: Rhode Island Secretary of State Nellie Gorbea meets with high school students during the Junior Achievement program

High School Request Form

Please carefully read through the delivery requirements before submitting a request for programming. By pressing submit on this form you are agreeing to all the delivery requirements.

You can submit your request below or download a PDF of the form and submit via fax to (401) 351-9860 or scan and email the form to Sara Schwartz at sara.schwartz@ja.org or Katharine Amaral at katharine.amaral@ja.org.

Contact Name

First Name

Last Name

Contact Direct Phone

(###)

###

####

Contact Email Address

School Name

School Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

School Phone Number

(###)

###

####

Principal

Principal Name

First Name

Last Name

Principal Email Address

(###)

###

####

Teacher

Teacher Name

First Name

Last Name

Teacher Email

Teacher Direct Phone Number

(###)

###

####

JA Program Name

Select One

Grade Level

Accomodations

Please code as follows for any needed accommodations: ESL (Spanish Material Requested), ELL (Multi-lingual Room), IEP/504 (Most/Whole Class), B/SC (Behavioral/ Self Contained Room), OA (Other Accommodations)

Number of classes/periods

Total Number of Students

Semester

Fall

Spring

Summer Programming

Are you able to provide computers and internet access?

Have you requested JA programs before?

By clicking submit you are agreeing to all the delivery requirements found on this page. Please carefully read through them before submitting a request for programming.