Elementary School Request Form

You can submit your request below or download a PDF of the form here and submit via fax to (401) 351-9860.

Please carefully read through the delivery requirements before submitting a request for programming. By pressing submit on this form you are agreeing to all the delivery requirements.

If you’re requesting elementary programs for a JA in a Day, please select that in the drop down below. If you have any questions, please contact Erin Cheschi at erin.cheschi@ja.org or Sara Schwartz at sara.schwartz@ja.org.

Teacher/School Contact Information

Contact Name

First Name

Last Name

School Name

School Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

School Phone

(###)

###

####

Contact Phone

(###)

###

####

Contact Email Address

Principal Name

First Name

Last Name

Principal Email Address

Format

JA Ourselves (5 sessions, Kindergarten)

# of Programs Requested

Grade Level

JA programs can be taught up or down one grade level.

Total # of Students

Month(s) Requested

JA Our Families (5 sessions, 1st Grade)

# of Programs Requested

Grade Level

JA programs can be taught up or down one grade level.

Total # of students

Month(s) Requested

JA Our Community (5 sessions, 2nd Grade)

# of Programs Requested

Grade Level

JA programs can be taught up or down one grade level.

Total # of Students

Month(s) Requested

JA Our City (5 sessions, 3rd Grade)

# of Programs Requested

Grade Level

JA programs can be taught up or down one grade level.

Total # of Students

Month(s) Requested

JA More Than Money (5 sessions, 4th grade))

# of Programs Requested

Grade Level

JA programs can be taught up or down one grade level

Total # of students

Month(s) Requested

JA Our Region (5 sessions, 4th Grade)

# of Programs Requested

Grade Level

JA programs can be taught up or down one grade level.

Total # of Students

Month(s) Requested

JA Our Nation (5 sessions, 5th Grade)

# of Programs Requested

Grade Level

JA programs can be taught up or down one grade level.

Total # of Students

Month(s) Requested

Other Elementary Programs

Choose one.

# of Programs Requested

Month(s) Requested

Grade Level

Total # of Students

ELL/ESL Classroom Needs

Please tell us about any classrooms per-grade level may need a Spanish/Dual Language Speaking Volunteer, and how many (if any) students may need materials in Spanish.

Submit

By clicking "submit" below, you agree to the program delivery requirements outlined on www.jarhodeisland.org/delivery-requirements

By clicking submit you are agreeing to all the delivery requirements found on this page. Please carefully read through them before submitting a request for programming.