Volunteer Registration Form for Pierce Middle School Career Day

Junior Achievement of Chicago

Volunteer Registration Form for Pierce Middle School Career Day

Junior Achievement is the world’s largest organization dedicated to inspiring and preparing young people to succeed in a global economy. Through a dedicated volunteer network, JA provides programs for students in grades K-12. JA has been a positive influence in this community for many years and we currently serve more that 43,000 students in nearly 100 schools through out Lake and Porter County.
Thank you for volunteering for the Pierce Middle School Career Day! We hope your time in the classroom provides you with a rewarding experience!
By sharing your personal and professional experiences with students from your community, you help them make the connection between what they are learning in school and what they will need to be successful in work and life.
A Career Day is one way to help educate students about Career Choices while stressing the importance of continuing their education beyond High School. We truly appreciate your support!
PLEASE PRINT CLEARLY FOR ACCURATE DATA ENTRY
Volunteer Info: Date: / /
Name: ______
First name Last name
Please check one: o Mr. o Ms. o Mrs. o Miss
Personal Email: ______
Personal Cell Phone: ______
Home Address: ______
City: ______State: Zip: ______
Company/ Organization: ______
Address:______
City: ______State: Zip: ______
Business Phone: ______
Business Email: ______
Fax: ______
Previous company/companies where you participated as a JA Volunteer:
Birth Month and Date: ______
Are you an Alumni of JA? ______
Have you ever been convicted of any crime other than a minor traffic violation? o Yes o No, If Yes, please briefly explain: (or attach form)
Signature:
Parent/Guardian Signature:
(required if under 18) / Ethnicity – Section 1 - Required
Please check only one box in this section:
o African-American o Asian o Hawaiian
o Alaskan Native o Caucasian o Hispanic
o American Indian o No answer provided
Gender (required) please check one: o Female o Male
Profession (Required):
Job Title:______
Please check a profession below that most closely matches your job profession.
o Accounting o Law
o Administration o Management
o Advertising o Manufacturing
o Agriculture o Marketing
o Architecture o Media
o Art o Medical
o Banking o Military
o Community Relations o Non-Profit Admin
o Computers o Nursing
o Conservation o Pest Control
o Construction o Physician
o Consulting o Plumbing
o Contractor o Programming
o Design o Publishing
o Education o Real Estate
o Electrical Engineer o Religion/Clergy
o Electrician o Retail
o Engineering o Sales
o Entertainment o Secretary
o Finance o Services
o Fine Arts o Stock Market
o Food Service o Student
o Government o Transportation
o Human Resources o Travel
o Insurance o Other______
Would you like to learn more about Junior Achievement’s Traditional Programs?
Yes_____ No______
Would like to volunteer for additional Career Days though out other schools in NW Indiana?
Yes_____ No______
If yes, do you have a city or school preference? Please list.
Visit our website at www.jachicago.org
Thank You!
Roz Malouhos, JA Program Manager

219-263-9843