Junior Achievement
of Brazoria County
104 W. Myrtle
Suite 218
Angleton, TX 77515
Phone:
979-549-0800
Fax:
979-549-0805
President:
Kim Effenberger
Program Manager:
Stephanie Ward
CLASSROOM ETHNICITY REPORT
This form is to be completed for After-School programs only.
CAMPUS INFORMATION (required)
School District: Select one...... Alvin-Manvel ISD Angleton ISD Brazosport ISD Columbia-Brazoria ISD Danbury ISD Pearland ISD PRIVATE SCHOOL Sweeny ISD Other (YMCA, etc)
Campus Name:
TEACHER INFORMATION (required)
Name:
Ethnicity: Select one...... American Indian Asian Black Hispanic Multi Racial No Response Pacific Islander White
Email:
Grade Level:
Gender: Male Female
VOLUNTEER INFORMATION
(if class was taught by someone other than the Teacher)
PROGRAM INFORMATION (required)
Program Name:
Program Start Date:
Program Completion Date:
STUDENT INFORMATION (required)
Total Number of Students:
Please enter the number of students for each ethnic group listed:
American Indian
Asian
Black
Hispanic
Multi Racial
Pacific Islander
White
