This form should be used for field trips that last only one day.  Students are not required to stay anywhere overnight.  A district transportation request and a school field trip checklist must be submitted as well.  This trip should also be added to the master school calendar.  A list of students leaving on the trip should be provided attendance when you leave.

Teacher:

Destination:

Date filed: Date of Trip:

Time departing school: Time returning to school:

Number of students on trip: Number of teachers (professional staff) on trip:

Number of adults (not professional staff) on trip:

How many class periods (other than your period) will the students miss?

Type of transportation:

Loading area for buses to depart and return:

What is the charge per student for the trip (funds handled through school accounts)?

Estimate student  (necessary) out-of-pocket expenses (food)?

Have you made provisions for students who wish to go on the trip but cannot afford it? If so, explain.

How will these funds be acquired?

If necessary, how do you plan to pay the cost of a substitute teacher?

If you need a substitute, please complete a professional leave form.

What is the purpose of this trip and how does it relate to your curriculum?

How do you plan to assess student achievement for this trip?

What will be provided for the students who do not participate?

Please attach the following items:

1. Proposed lesson plan for the trip.

2. Field trip checklist and items required.

3. Itinerary for the trip.

4. Cell phone number where we can contact teacher on trip.

5. List of chaperones (which must be approved prior to the trip) on district chaperon approval form.

A roster of students on the trip should be provided to the attendance office at the departure time.  Also, each student must have a  parent permission form before departing. These should be sent to the main office prior to departure.

For Office Use

______Approved  ______Disapproved

Principal__________________________  Date:____________________

Comments:_______________________________________________________________

_______________________________________________________________________

_______________________________________________________________________