Volunteer Registration (Northeast)

Title 1:

First Name:

Last Name:

Preferred Email:

Home Phone:

Home Country:

Home Mailing Address:

Home City:

Home Province:

Home Postal Code:

Personal agreement to JA using name and/or picture:

Personal agreement to school year responsibilities:

Personal facebook URL:

Personal notes / comments:

Personal twitter @ handle:

Vol/Edu language to deliver/receive programs:

English

Français

Both

Volunteer employer / school:

Volunteer employment status:

Volunteer last school year to volunteer with JA:

Volunteer reference 1 email address:

Volunteer reference 1 name:

Volunteer reference 1 phone number:

Volunteer reference 1 relationship:

Volunteer reference 2 email address:

Volunteer reference 2 name:

Volunteer reference 2 phone number:

Volunteer reference 2 relationship:

Account Information

Username:

Password:

12 characters or more.

Confirm Password:

Terms and Responsibilities:

By applying to be a Junior Achievement (JA) volunteer and submitting the Volunteer Application Form, I hereby declare that all information is accurate and complete.
- I agree to uphold the core values and mission of JA
- I authorize JA to contact the above references in connection with my volunteer application
- I understand that I may be required to provide further information in order to validate my volunteer status, including, but not limited to, providing a Police Records Check and/or a Vulnerable Sector Screening
- I release and hold harmless the above references and JA from any liability

Cape Breton

• Volunteer

• Student

Halifax

• Volunteer

• Student

Northeast

• Volunteer

• Student

Southwest

• Volunteer

• Student