2018-19 JA Company Program Application

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2018-19 JA Company Program® Student Application

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2018-19 JA Company Program Sites

Accenture (800 N Glebe Rd #300, Arlington, VA 22203)

Meeting Day/Time: Mondays from 5:30 pm - 7:30 pm (First meeting on October 15, 2018)
Mandatory Student/Parent Orientation on October 10th at 5:30 pm (Arlington Central Library)

Microsoft Store (Westfield Montgomery Mall: 7101 Democracy Blvd, Bethesda, MD 20817)

Meeting Day/Time: Tuesdays from 5:30 pm - 7:30 pm (First meeting on October 16, 2018)
Mandatory Student/Parent Orientation on October 9th at 5:30 pm

JA Finance Park - Prince George's County (960 Nalley Road, Landover, MD 20785)

Meeting Day/Time: Wednesdays from 5:30 pm - 7:30 pm (First meeting on October 17, 2018)
Mandatory Student/Parent Orientation on October 17th at 5:00 pm

JA Finance Park - Fairfax County (4099 Pickett Road, Fairfax, VA 22032)

Meeting Day/Time: Thursdays from 5:00 pm - 7:00 pm (First meeting on October 18, 2018)
Mandatory Student/Parent Orientation on October 11th at 6:00 pm

Youth Foundation for Networking & Fellowship (6506 Loisdale Road (lower level), Springfield, VA 22150)

Meeting Day/Time: Saturdays from 11:00 am - 1:00 pm (First meeting on October 20, 2018)
Mandatory Student/Parent Orientation on October 20th at 10:00 am

Parent & Emergency Contact Information

Parent/Guardian Name*

First Name

Last Name

Relationship to student*

Parent/Guardian Phone*

Parent/Guardian Email*

Supplementary Information

Why do you want to participate in the JA Company Program?*

What experience and/or education do you have in business and/or entrepreneurship?*

Transportation and Attendance Agreement

Please note how the student will travel to and from JA Company Program Meetings.*

Please explain:

By checking this box, I recognize that Junior Achievement® is not responsible for any transportation related injuries or damages traveling to and from all JA Company Program meetings and events.

By checking this box, I understand that the JA Company Program will meet weekly from October to April and that my full attendance is required. Any absences must be excused by either my JA Mentor or JA staff member. If my excused absences exceed three in a semester, I understand I may be asked to leave the program.

Code of Ethics

To ensure the safety and well-being of all students, staff, and volunteers at JA Company Program meetings, it is important that everyone understands and follows the same standards. Please take the time to read and sign the Code of Ethics. Student and parent/guardian signature is required below. If misconduct does occur, parent/guardian will be notified immediately.

The possession or use of alcohol, tobacco, illegal drugs or weapons is not permitted.
Sexual activity is not permitted.
Students are not allowed to have visitors onsite during the program.
Students must be present at and on-time to all meetings, speakers and other activities and functions.
Students must act professionally and appropriately during all speakers’ presentations, workshops, company meetings and activities. This includes, but is not limited to: not sleeping/putting head down, listening to iPods, texting, etc.
Appropriate clothing must be worn at all times during the program (details will be provided in a welcome packet to student upon program registration). Shoes and shirts are required at all times. Clothing with inappropriate or explicit language or graphics is not allowed.
JA of Greater Washington Staff maintains an environment where harassment or discrimination of any kind is unacceptable. No staff member, volunteer or program participant shall harass or discriminate against another staff member, volunteer or program participant on the basis of race, color, creed, religion, gender, age, national origin, citizenship, veteran or marital status, sexual orientation or the presence of any sensory, physical, mental handicaps or other legally protected status.

By signing below, the student and parent/guardian understand the code of ethics set forth by JA of Greater Washington and the student agrees to abide by the code of ethics at all times. Serious misconduct will be reported to your parents/guardians, principal and/or other authorities.

I understand the code of ethics set forth by Junior Achievement of Greater Washington and that any violation of this code of ethics could result in my student's behavior being reported to me, school officials, or authorities.*

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Parent/Guardian: Use your mouse or finger to draw your signature above

I understand the code of ethics set forth by Junior Achievement of Greater Washington and that any violation of this code of ethics could result in my behavior being reported to my parent/guardian, school officials, or authorities.*

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Student: Use your mouse or finger to draw your signature above.

Media Release

To be completed and signed by parent/guardian.

The JA Company Program is an exciting new program that we will want to feature in Junior Achievement’s own communications as well as in the news media. Junior Achievement® and their designees have the irrevocable right and permission to:

Reproduce, use, re-use, publish, display, copyright and distribute all media taken in which your student might appear and in connection with any and all media now known or hereinafter developed, for all purposes and in perpetuity.
Reproduce, use, re-use, publish, display, copyright, and distribute the same, individually or in conjunction with other photographs, images, text, and/or captions in connection with any promotion, advertising, and publicity of Junior Achievement in all media for all purposes and in perpetuity.

Junior Achievement is released and discharged from any and all claims, demands and liability in connection with the use of such media in connection with Junior Achievement, including but not limited to claims for libel, invasion of privacy, rights of publicity and/or copyright infringement. The copyright to all media resides with Junior Achievement.

Any questions or concerns about this media release should be directed to Gayle Robinson, Director of Program Innovation at gayle.robinson@ja.org.

Parent/Guardian, by signing below you indicate that you understand the above media release and agree to the terms listed.**

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Use your mouse or finger to draw your signature above

2018-19 JA Company Program® Student Application

JA Company Program Site Selection

Parent & Emergency Contact Information

Supplementary Information

Transportation and Attendance Agreement

Code of Ethics

Media Release