JA Company Application

Student ID*

Student Name*

First Last

Gender Identification*

My pronouns are...*

Birth Date*

Are you a*

Address*

Street Address City State / Province / Region ZIP / Postal Code

Student Email*

Please do not use official school email

Email is one of our primary means of communicating information pertaining to the JA Fellows program. Checking your email & the JA Fellows website regularly will ensure your student's success. (Please notify us at [email protected] if your email should change)

Cell Phone*

Cell Services Provider*

T-Mobile, AT&T, Verizon, etc.

Home Phone*

Demographic Information

Information pertaining to Ethnicity/Race, Income Level, and Test Scores has no bearing on acceptance; however, it assists us with grant compliance and reporting to donors, who make the JA Fellows program possible.

Ethnicity*

Race*

School Information

High School Name*

If Other

Grade Level*

County*

Student Lunch Status*

Cumulative GPA*

Parent Information

Parents/Guardians, please read and complete Parent and Consent Information. Failure to complete will result in application being considered incomplete:

Parent Name*

First Last

Parent Email*

Parent Cell Phone*

Language*

Is a language other than English used in the home? (select one)

Yes
No

If Yes

Type in language(s)

Secondary Parent Name

First Last

Second Parent Email

Second Parent Cell Phone

Parent Address*

Please ensure that your mailing address is accurate. Should your address change, please notify us immediately to update your record.

Street Address City State / Province / Region ZIP / Postal Code

What Is Your Shirt Size?*

Please select one

Does your child have any medical conditions that we should be aware of?*

Yes
No

Medical Conditions

Add your response here

Allergies, Reactions or Dietary Restrictions*

None
Aspirin
Penicillin
Dairy
Gluten
Peanuts
Insect bites or stings
Other

Other Allergies or Dietary Restrictions

Please list here

Student Expectations

Please sign and date below to confirm acceptance of the JA Student Expectations.

JA Student Expectations*

I will adhere to JA Guiding Principles (as required by my program).
I will display professionalism in demeanor, commitment and a GREAT ATTITUDE
I will regularly attend all meetings/sessions and special events, barring unforeseen circumstances, and I will notify my JA program staff and volunteers two weeks in advance of any planned absences or tardiness. I understand that 2 unexcused absences will result in dismissal from the program.
I understand that my participation during scheduled meeting times is essential to my success.
I understand that communication between JA staff, volunteer advisors, and students is vital. Therefore, I will check my e-mail account regularly.
I agree not to directly or indirectly solicit support from Junior Achievement supporters either on my own behalf or on behalf of any person at any time during or after my involvement Junior Achievement.
I will act in accordance with my school's and/or district's student code of conduct policy, which is not limited to the ethical and responsible use of social media platforms and other cyber solutions.
My parent/guardian has read and signed the online parent information and consent form.

Student Signature*

Parent/Guardian Consent

Your student is taking a step toward his or her future by applying to be a JA student. In order to ensure Junior Achievement of South Florida provides a productive and safe environment for all students and volunteers, we require you to review the information below and indicate your consent by checking each box. If you have questions or concerns, please contact a JA representative at (954) 979-7100.

Parent/Guardian Consent*

I will support my student in upholding the Student Expectations listed above.
I, the parent/guardian of participating JA Student, have read and signed the online parent information and consent form.

Program Removal Policy*

I understand that once my son/daughter has been accepted into any JA program, they are expected to follow all rules and guidelines. At any time, if expectations are not met, students will be asked to leave the program. We Junior Achievement of Florida reserve the right to release students at will.

Photo Release*

I agree that regarding photographs and video taken during the duration of the program, all appropriate and necessary permissions and consents by program participants are implied and sufficiently obtained by willing registration and/or attendance at all JA events, including without limitation any copyright licenses and waivers of attendee's rights of publicity or rights of privacy. By attending the JA events, participants or their representatives, agree to not make claims against JA or the photographer(s)/videographer(s) taking pictures and/or video on behalf of JA, as a result of the use, publication or reproduction of their photographs and/or videos. In no event shall JA or the photographer(s)/videographer(s) that takes pictures and/or video on behalf of JA, be liable for any indirect, incidental, consequential, special, or exemplary damages or lost profits due to use, publication or reproduction of said photographs and/or videos, even if JA or the photographer(s)/videographer(s) that take pictures and/or video on behalf of JA, have been advised of the possibility of such damages.
I disagree to the above photo release

Student Evaluation*

I understand that as a part of Junior Achievement of Florida’s commitment to continual improvement, Junior Achievement of South Florida is involved in studies of student outcomes. In submitting this application, I grant permission for Junior Achievement of Florida to request the school records of the student for whom I am submitting this application, including such information as my child’s attendance, test scores, and other academic outcomes, and demographic information for the duration of the study. I further understand that this information may be used for studies of Junior Achievement of South Florida and that all student level information will remain confidential as required by the Family Educational Rights and Privacy Act (FERPA). My decision whether or not to participate in the study will have no impact my child’s participation in Junior Achievement of South Florida’s program. Further, there are no discernible risks in participating in the study and while there are no direct benefits to myself or my child, Junior Achievement and society at large may benefit from the increased knowledge about potential Junior Achievement student achievement and parental satisfaction
I disagree to the above evaluation policy

Emergency Contact & Health Information*

I agree that the Emergency Contact and Health Information for my child is correct and complete to my knowledge. If an injury or other medical condition occurs or arises, I hereby give permission to Junior Achievement of South Florida staff or volunteer to provide routine first aid and seek emergency treatment. I agree to the release of any record necessary for treatment, referral, billing or insurance purposes. I understand that I am financially responsible for charges to the attending physicians or health care unit.

Solicitation Policy*

I agree not to directly or indirectly solicit support from Junior Achievement supporters (e.g. volunteers, company/organization host sites, etc.) either on my own behalf or on behalf of any person at any time during or after my students' involvement with Junior Achievement.

By entering your name below, parents/guardians are demonstrating your understanding of the commitment necessary to become a JA Fellow.

Parent/Guardian Digital Signature*

Today's Date*

JA Fellows Application 2023-2024

Demographic Information

School Information

Parent Information

Student Expectations

Parent/Guardian Consent