Local Programs

Teacher Class Request

Are you a teacher who would like to request a JA Program in your classroom? Please complete the form below one time per program/class period requested and a JA staff member will contact you when a volunteer has been matched with your class. If you have any questions, please contact Ron Wigglesworth, Program Manager (ron@jalexington.org or 859/219-2423). Click here for program descriptions.

Teacher Information

Title

First Name

Middle Initial

Last Name

Email Address

Work Phone

Work Fax

Home Address:

City:

Zip:

Home Email:

Home Phone

Planning Time

Best way to reach me at school:

For funding and grant information only, please complete the following. (Information will not be shared on an individual basis.)

Gender: Ethnicity:

Volunteer Information (Please add phone/email if known)

Volunteer Requested

Volunteer Work Phone:

Volunteer Home Phone:

Volunteer Email:

Has agreed to teach your class? Yes No

Class Information

School

Grade Being Taught

Elementary Program Requested:

Middle School Program Requested:

High School Program Requested:

Semester Preference

Time Preference Month Preference:

Number of Students

Have you ever hosted a JA class before? Yes No
(First time teachers will need to meet with JA Staff)