Class Ending Date
"After School" or "Community Partner" Classes Only

Please complete after you have taught your final class
* Required Field


Volunteer Name:*
Email Address:*
Company:
School/Community Partner Site:*
Program Name:*
# of Students in Class:*
Ethnicity:* American Indian/Alaskan      Asian        Black, not Hispanic 
   Hawaiian/Pacific Islander Hispanic    White, not Hispanic
  (Please indicate the # of students in the class belonging to each ethic category above.)
I completed * number of lessons for my class on:*  (Date)
 For a listing of required number of lessons for each JA curriculum, click here
 
I used the Excellence in Ethics curriculum provided with my kit.*
Would you like to volunteer again?*     Where?

Comments:

   

*  Due to requirements for certain grants and funding, we need to collect ethnicity information for "after school" or "Community Partner" classes only.