20/21 JA Company Program Pre-Program Survey (EI) Tell Us about You Question Title 1. What are the first 3 letters of your last name? OK Question Title 2. When is your birthday? Month Date Month/Date January February March April May June July August September October November December Month/Date Month menu 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month/Date Date menu OK Question Title 3. What is your teacher's last name? OK Question Title 4. What grade are you in? 9th 10th 11th 12th Other (please specify) OK Question Title 5. What school do you attend? OK Question Title 6. How many times have you participated in JA In the past? This is my first time 1 time 2 times 3 times 4 times 5 or more times OK NEXT