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JA Simulation Visit Form
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JA Discovery Center Simulation JA Finance Park
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School/Organization: ____________________________________________________________
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Grade Level: ___________________________________________________________________
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Lead Teacher: __________________________________________________________________
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Directions: Please complete the boxes below and submit to Paul Colson, paul.colson@ja.org, two weeks prior to your visit date.Visit Date:Total Students
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XX-XX-XXXX0
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Standard Simulation Hours are 9am-1:30pm (CST)
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Estimated Arrival Time
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Estimated Departure Time
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Expected Student Attendance:
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# of SPED Students (Please specify SPED needs, if possible):
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# of ESL/ELL Students (Please specify languages, if possible):
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# of Teachers attending:
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# of Administrators/other school staff attending:
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1st Point of Contact Name:
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1st Point of Contact Cell Phone Number:
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1st Point of Contact Email Address:
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2nd Point of Contact Name: (in case 1st POC cannot be reached)
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Cell Phone Number (for 2nd Point of Contact):
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For any students that might need additional support during simulation, please indicate the number of students for each of the following.

Please include any additional information that would help our JA staff support these students.		Food Allergies:
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Asthma:
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EpiPen:
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Diabetes:
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Seizures:
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Wheelchair:
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Walker/Crutches:
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Vision Impairments:
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Hearing Impairments:
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Other:
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