Section 1 - Contact Information
(Required)
School :              County: 
School Address: 
City:       State:       Zip: 
Principal:            School Hours: 
Number of classes attending:
       Total number of students: (projected)
Primary Contact:      School Phone:       Ext:  
                 Email:       
Please list the names of the teachers that you anticipate will be teaching the program & their requested orientation date. If the name of the teacher is not known at this time, please indicate "unknown".
  • All new teachers are required to attend New Teacher Training
  Teacher Subject Training Date Email
1
2
3
4
5
6
7
 

Please indicate your school schedule type by checking one or more of the items below:

        Traditional - 7 or 8 periods per day every day (semester length is 18 weeks)

  Block 4  (meets every day for 9 weeks)

  Modified Block

  Trimester (semester length is 12 weeks)

 
Section 2 - School Dates
(Required)
Please list two possible dates for your school to attend Finance Park.  (Dates will be scheduled on a first-come first-served basis.)  Be sure to consider holidays, breaks, in-services and conferences.  (If you need to schedule multiple days, please consider your multiple days as one selection.)

First Day

 Option 1 -      Option 2 -
        ***For schools who need to schedule more than one day for the school year:***

Second Day

 Option 1 -      Option 2 -

Third Day

 Option 1 -      Option 2 -

Fourth Day

 Option 1 -      Option 2 -
 
 
Section 3 - Share a day
(Optional)
            We prefer to share a day with: (School Name)
The contact teacher for this school is: (Teacher Name)
 
Section 4 - I agree to:
(Required)
Participating Educators/Schools Agree to:

■

 Verify that the requested date works with my school calendar.

■

 All new teachers must attend training.

■

 Prepare students for the simulation using provided materials.

■

 Recruit a minimum of 1 adult volunteer per 6 students and inform them of their training session. (Numbers are split on share a days.)

■

 Arrange transportation to accommodate a 4.5 hour simulation.

Additional Comments/Questions:

 
 
Contact Information:
Jennifer Hathaway
Jennifer.Hathaway@ja.org
Junior Achievement of Northern Indiana
601 Noble Drive
Fort Wayne, IN 46825
Phone: 260-484-2543
Fax: 260-483-2133
www.JANI.org