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Basic Information

Name(s) of Staff Member Filing Request

Date of Trip

Day of the Week:

Time of Trip

Bus Leaves at: ___AM PM Bus returns at: ___ AM PM

(No later than 2:30 unless special permission given)

Destination and/or Preliminary Itinerary

Address

Cost per Student

$

Fundraising Events(if applicable)

School Personnel Chaperones/Special Needs Accommodation

School Personnel Attending

1.

2.

3.

Chaperones Attending (May be submitted later, but no later than 3 days prior to trip.)

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

Special Accommodations Needed (special education and/or special needs students)

Arrangements for Class Coverage and Students Not Attending

Class Coverage

Substitutes needed? No Yes How many?

Arrangements for students not attending

Curriculum Connection

Subject:

State Standard:

Standard Skill:

Subject:

State Standard:

Standard Skill:

Subject:

State Standard:

Standard Skill:

Subject:

State Standard:

Standard Skill:

Approved Denied _________________________________, Principal