Request for Industry Resources

 Resource Application

The ___________ Academy is developing a resource pool in order to support the current Academy curriculum. Industry involvement is imperative to the partnership concept. By completing this form, you are indicating you are interested in joining the resource pool.

Based on the Academy academic calendar and needs, you may be contacted during the year by an Academy staff member in order to plan and organize an activity with you.

I would be interested in participating in the following way(s):

_____ Classroom Speaker
_____ Math _____ History
_____ English _____ Computer
_____ Science _____ Other ______________________
_____ Job Skills
_____ Curriculum Advisor in (subject): __________________________________
_____ Communication/Publicity (newsletter, brochures, media, etc.)
_____ Fund Raising
_____ Fieldtrip/Site Tour
_____ Training Class (at school or company)
_____ Lab Assistant (assisting with technical lab class)
_____ Mock Interview Workshop
_____ Special Projects
_____ Job/Career Fair

Your Name: _____________________________________

Male _______ Female _______

Company Name: __________________________

Job Title: _________________________

Company Address: ________________________

Telephone: ________________________

Description of Job Duties: _____________________________________________________

___________________________________________________________________________