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.

Teacher/School Contact Information
Teacher Name *
Teacher Name
School Address *
School Address
School Phone
School Phone
Teacher Phone
Teacher Phone
Principal Name *
Principal Name
JA Ourselves (5 sessions, Kindergarten)
JA programs can be taught up or down one grade level.
JA Our Families (5 sessions, 1st Grade)
JA programs can be taught up or down one grade level.
JA Our Community (5 sessions, 2nd Grade)
JA programs can be taught up or down one grade level.
JA Our City (5 sessions, 3rd Grade)
JA programs can be taught up or down one grade level.
JA Our Region (5 sessions, 4th Grade)
JA programs can be taught up or down one grade level.
JA Our Nation (5 sessions, 5th Grade)
JA programs can be taught up or down one grade level.
Total # of Students
Volunteer Information
If you have had a JA program in the past and would like the volunteer to return to your class for the 2017 - 2018 academic year, please provide his/her information below.
Volunteer #1 Name
Volunteer #1 Name
Volunteer #2 Name
Volunteer #2 Name
Submit
By clicking "submit" below, you agree to the program delivery requirements outlined on www.jarhodeisland.org/requests/delivery-requirements