2014
• All applicants must have an e-mail account that is checked regularly. The primary mode of communication for the program is via email. We welcome you to share these emails with your parents as well.
• Your attendance, active participation, & positive attitude are vital to your success in the program.
• All applicants must have reliable transportation to meetings. Meetings will be held at 4756 Mission Gorge Place San Diego, CA 92120, which is accessible by car of trolley.
• Your application must consist of:
• A completed Parent/Guardian Consent Form
• A schedule of availability
• A completed LMC Client Demographics Form
Program Duration: February – December 2014
Time Commitment:
Meetings will be held once per month
Required to attend at least one event
Mailing Address: 4756 Mission Gorge Place
San Diego, CA 92120
Email: karlaeaston@jasandiego.org
Phone: 619.906.4933

Personal Information:
First Name: _________________________ MI: ____ Last Name: _________________________
Gender (M/F): _______ Birth Date: ___________________________
Contact Information:
Student Email: _______________________________________________
Home Phone: ________________________ Cell Phone: ____________________________
Demographic Information: (optional)
Information pertaining to Ethnicity/Race may be used in the future to submit with grant applications that
could support Junior Achievement Programs
Ethnicity/Race: ______________________________________
Education Information:
High School Name: __________________________________________________
School Phone Number: __________________________
Address: _________________________________________
City: _________________________ State: ______ Zip Code: __________________
Current Grade Level: _________________________
Mode of Transportation to Meetings:
My Car
Parent/Guardian
Public Transportation
Other:

Primary Parent/Guardian Information:
First Name: _______________________ Last Name: ___________________________
Home Phone: ____________________ Cell Phone: ________________________
Permanent Address: _________________________________________________
City: _________________________ State: ______ Zip Code: ____________________
Relationship to Student: ___________________________
Secondary Parent/Guardian Information:
First Name: _______________________ Last Name: ___________________________
Home Phone: ____________________ Cell Phone: ________________________
Permanent Address: ______________________________
City: _________________________ State: ______ Zip Code: ____________________
Relationship to Student: ___________________________
Emergency Contact (if different than primary/secondary):
1) Name: _________________________________ Phone: ________________________
Relationship to student: _____________________________________
2) Name: _________________________________ Phone: ________________________
Relationship to student: _____________________________________
If your child will be carpooling, or please list the authorized contact’s information below:
Name: __________________________________ Phone: ____________________________
Please list any pertinent student Medical Issues/Allergies below:

Your child is taking a positive step toward his/her future by applying to be a Junior
Achievement Ambassador. Please, take time with your child to read and sign this form to demonstrate your understanding of the commitment to this program.
Don’t Forget:

Students must regularly attend all scheduled sessions, barring unforeseen circumstances, and must notify JA staff in advance of any planned absence of tardiness. Students are required to attend at
 least one event outside the monthly sessions.
Communication between JA staff, parents/guardians and students is vital. Therefore, students must have an e-mail account that they check regularly.

Students must have a reliable mode of transportation for weekly meetings. Our office is within
 walking distance of the Grantville trolley stop.
Professionalism in demeanor and commitment to the program is expected by students accepted into the program.

A GREAT ATTITUDE!
After students have completed the application and interview process and have been accepted into the program, they are expected to follow all rules and guidelines that have been explained throughout the application process.
Please complete the following statement in order to give consent and agree to all guidelines of the JA
Ambassador program:
I _________________________________ give my child _____________________________ permission to participate in the 2014 JA Ambassador program. I understand the expectations and requirements of the program, and I support them.
Parent/Guardian Signature: __________________________________ Date: ______________
Students Signature: _________________________________________ Date: ______________
As a JA Ambassador, your child will have the opportunity to represent Junior Achievement at various events throughout San Diego and as a result, he/she may be photographed or videotaped for use in communications and marketing materials for Junior Achievement.
Yes, my child has my permission to participate in the JA Ambassador program, and I understand that he/she may be photographed, videotaped and/or interviewed. These
pictures/interviews may appear in print, on the web or broadcast for publicity purposes.
Parent/Guardian Signature: ___________________________________ Date: ______________________

Below, please indicate days and times that you ARE available for JA Ambassador meetings (typically once per month) with an “X” in the corresponding box.
Session Time Tuesday Wednesday Thursday Friday
3:30 pm – 5:30 pm
4:00 pm – 6:00 pm
4:30 pm – 6:30 pm
5:00 pm – 7:00 pm
If your day/time preference is not included above, please list it below:
Day: ______________________________ Time: _____________________________
 Meetings and days will be selected once applications are reviewed and all student schedules are taken into account.
What is your experience with Junior Achievement?
___ JA BizTown ___ Summer Camp ___ I had JA visit my school class ___ N/A
___ I participated in JA Afterschool Programs (Company Program, Titan, Job Shadow, etc.)
Events/Activities you will have the opportunity of participating in this year! 
JA BizTown volunteer
Annual JA San Diego Business Hall of Fame
JA Golf Classic Tournament
Cortez Racing JA Charity Regatta (Sailing)
JA Bowl-A-Thon Tournament
JA In-class volunteer
And so much more!