SAMPLE

XYZ Charter

719 Fourth Street

Anytown, TX

555/555-1234

 

FIELD TRIP REQUEST

 

Submit to Campus Director for approval at least four weeks in advance.

 

Teacher/Staff Member: ______________________________________________________

 

  1. Field Trip to: _________________________________________________________
  2. Instructional Objective: ________________________________________________
  3. Date(s) of Trip: _______________________________________________________
  4. Time of Departure: ____________________________________________________
  5. Number of Students Participating: _______________________________________
  6. Mode of Transportation: _______________________________________________
  7. Number of Chaperones Required: _______________________________________
  8. Names of School Personnel: _____________________________________________
  9. Names of Non-School Personnel: _________________________________________
  10. Class Coverage: Please list names of colleagues who will cover your class(es) and indicate the period(s) they will be covering.

___________________            ____________________            __________________

___________________            ____________________            __________________

  1. Administrator Approval (expect process time)

Approved____________________________            Date_______________________

Denied______________________________            Date_______________________

 

 

 

III. 56