JA Fellows Application

Student ID*
Student Name*
First Last
Birth Date*
MM slash DD slash YYYY
Are you a*
Address*
Street Address City State / Province / Region ZIP / Postal Code
Student 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 jafellows@jasouthflorida.org if your email should change)
Cell Phone*
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*
School Information
High School Name*
If Other
High School Teacher Name*
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*
Home 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
How did you find out about JA Fellows?*
- Twitter
- School Presentation
- School Newsletter
- JA Job Shadow
- Flyers
- JA Day at high school
- Website
- Facebook
- Counselor/Teacher
- Parent
- Friend
- DECA
- FBLA
- Other
What Is Your Shirt Size?*
Please select one
Hidden
What is your shirt size?*
- Women's Small
- Women's Medium
- Women's Large
- Women's XLarge
- Women's XXLarge
- Men's Small
- Men's Medium
- Men's Large
- Men's XLarge
- Men's XXLarge
- Other
Does your child have any medical conditions*
- Yes
- No
Allergies or Reactions?*
- None
- Aspirin
- Penicillin
- Dairy
- Gluten
- Peanuts
- Insect bites or stings
Other Allergies
Please sign and date below to confirm acceptance of the JA Fellows Student Expectations.
JA Fellows Student Expectations*
- I will adhere to JA Fellows’ Guiding Principles and Pledge
- I will display professionalism in demeanor, commitment and a GREAT ATTITUDE as a JA Fellow
- I will regularly attend all meetings/sessions and special events, barring unforeseen circumstances, and I will notify my JA Fellows colleagues, JA Fellows staff and volunteers two weeks in advance of any planned absences or tardiness. I understand that 3 unexcused absences will result in dismissal from the program.
- I understand my company expects me to actively participate outside of scheduled meeting times and that this is essential to my success as a JA Fellow.
- I understand that communication between JA staff, volunteer advisors, and students is vital. Therefore, I will check my e-mail account regularly.
- I will secure reliable transportation for weekly meetings
- 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 Fellow. In order to ensure Junior Achievement of 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 Fellows representative at (954) 979-7100 or jafellows@jasouthflorida.org.
Parent/Guardian Consent*
- I will support my student in upholding the JA Fellows Student Expectations listed above.
- My student will have valid transportation to and from meetings/sessions and all special events. Transportation services is not the responsibility of JA of South Florida.
- I, the parent/guardian of participating JA Fellows Student, have read and signed the online parent information and consent form.
Dismissal Policy*
- I understand that once my son/daughter has been accepted into JA Fellows 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 JA Fellows (JAF), all appropriate and necessary permissions and consents by program participants are implied and sufficiently obtained by willing registration and/or attendance at all JAF events held in 2021-2022, including without limitation any copyright licenses and waivers of attendee's rights of publicity or rights of privacy. By attending the JAF events, participants or their representatives, agree to not make claims against the JA Fellows (JAF), Junior Achievement of Florida (JASF), or the photographer(s)/videographer(s) taking pictures and/or video on behalf of JAF or JASF, as a result of the use, publication or reproduction of their photographs and/or videos. In no event shall JAF, JASF, or the photographer(s)/videographer(s) that takes pictures and/or video on behalf of JAF or JASF, 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 JAF, JASF, or the photographer(s)/videographer(s) that take pictures and/or video on behalf of JAF or JASF, have been advised of the possibility of such damages.
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
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*
MM slash DD slash YYYY

JA Fellows Application 2022-2023

Demographic Information

School Information

Parent Information

Parent/Guardian Consent