Extended Field Trip Form

Extended Field Trip

HAMBURG CENTRAL SCHOOL DISTRICT 

APPLICATION FOR AN EXTENDED FIELD TRIP

Extended Field Trips include out of state or out of country trips; and all trips which require that students obtain overnight accommodations.

ANY FIELD TRIP REQUIRING BOARD OF EDUCATION APPROVAL MUST BE PROCESSED IN THE FOLLOWING MANNER:

  1. Application is to be completed with estimated costs, tentative itinerary, etc;
  2. Application is sent to the Building Principal for action to verify that the trip is educationally sound. The basis for that determination is that the trip will enhance the academic curriculum as it relates to the New York State Standards;
  3. With the Principal’s approval, the application form is sent to the Assistant Superintendent for Student Services, Curriculum and Instruction, then the Assistant Superintendent for Administrative Services & Finance.  If approved by both Assistant Superintendents, it is sent to the Superintendent for action;
  4. With the Superintendent’s approval, the application form is sent to the Board of Education for approval. With the Board of Education’s approval, the organization can THEN proceed with plans for the field trip. The application should be re-submitted to the Board if any major changes occur.

APPLICATION MUST GO BEFORE THE BOARD AT LEAST NINE (9) WEEKS PRIOR TO THE DATE OF THE FIELD TRIP AND MUST BE IN THE SUPERINTENDENT’S OFFICE BY THE WEDNESDAY PRECEDING THE BOARD MEETING.

*Denotes a Required Field


*REQUEST SUBMITTED BY

*Email of requestor: 

Telephone

*Building

*Date of Request

*Grade/Department:  

*Dates of Trip

*Destination

*Names of Teachers Attending: 

Names of Others Chaperones: 


*Instruction Objectives: (Be specific.  Include prerequisites, proficiency level desired and measurement)

*Activities: (How will the students be prepared for the trip as an instructional activity, what instructional activities will occur on the trip, etc.?)

*Correlation: (upon return, what activities will occur to enrich the experience and to determine if the objectives were achieved, what subject areas will correlate and how?)

*Evaluation Procedures:  (What provisions will be made to help participants keep up with classes missed, what plans are made for those students who will not participate in the field trip project?

 



ESTIMATED DISTRICT COSTS (to be completed by school office)

*Substitute RequiredYes  No           If yes, # of Days Substitute Required: 

Staff Members Attending:       # of days involved 

     

     

     

     

     

Misc. Costs to the District: (specify items)

     

   

     

*Supervision Pay Requested     Yes     No    If yes, 

*Total Estimated District Costs   

*School Transportation?   Yes   No   If yes, Name of bus company: 

                                                 # to be transported:  

*Insurance Coverage        Yes     No    If yes, Name of Carrier:      

                                                 To be paid by:  

       Has insurance carrier been notified thirty (30) days prior to the trip?  Yes    No

Costs to Parents: (specify items)

   

   

   

*Total Estimated Parent Costs:  


*Will students be raising money for this trip?   Yes    No

      If yes, please indicate how this will be done: 

*How will parents be informed as to the purpose, scope, other related factors?

 



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