JA BizTown Information and Program Request

If you would like to learn more about participating in the JA BizTown program, please provide the following information and we will contact you:

School District: 

School: 

Contact Person: 

E-mail Address: 

School Phone:  School Fax: 

(The SUBMIT button is at the bottom of this page)

If you are more than just interested and want to begin planning your school's participation, please provide the following information in addition to the above information:

Please select your preferred month that you would like to visit JA BizTown.  We will do our best to accommodate your request.  Please list your first and second choices below:

First Choice: <-- Make Selection -->JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember                    Second Choice: <-- Make Selection -->JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember

The JA BizTown program is designed for participation by all the fifth grade classes in a school.  Please complete the following information for each class:

Teacher First Name:  Last Name:  Total Students: 

Teacher First Name:  Last Name:  Total Students: 

Teacher First Name:  Last Name:  Total Students: 

Teacher First Name:  Last Name:  Total Students: 

Teacher First Name:  Last Name:  Total Students: 

Teacher First Name:  Last Name:  Total Students: 

Teacher First Name:  Last Name:  Total Students: 

Teacher First Name:  Last Name:  Total Students: 

Please include any special information that you would like us to consider in scheduling your school's visit: