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Colchester Public Schools
Application for Approval of Field Trip
Overview: This form must be completed by all staff to request approval of a field trip.
Directions:
1. Complete the form attaching all applicable documentation and submit to your administrator. The application
must be submitted at least two weeks prior for in-state field trips, and two weeks and two months prior for
out-of-state trips.
2. The Administrator will recommend or not recommend. If approved, the form must be sent to the
Superintendent.
3. The Superintendent will either recommend or not recommend and will bring to the Board of Education if the
request is for an out-of-state field trip.
4. If applicable, the Board of Education reviews and makes the final decision.
Today's Date: 6/12/23
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Applicant Name: Lynn Goodwin Method of Transportation: Cs 4 oh bus
School: WJJMS Bus Service Number(s) (applicable): / A
Grade(s) and Group(s): gin Grade band/Cheruo Number of Students: 5 ()
Date(s) of Trip: Apri it, 2024 Number of Day(s) of Trip: |
Event:
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Destination: Phone Number:
New Yorke \- 840-377-7806
Address State:
(for each destination): al 4 w une St. NudYore, NY NY
Time of Departure From School: 7 Aw Special Clothing and/or Equipment Required:
Time of Arrival Back at School: 4 pm W/k
*Cost to Student: $ IG. 60 Suggested Student Pocket Money: $ 10.60
1. Name: Lynn Goodwin Cell Phone:
2. Name: Keith WMorvissete Cell Phone: Fo
List all adult chaperones: Ratio of adult chaperones to students must be at least: 1:5 for Grades K-2, 1:8 for Grades 3-5; 1:10 for
Grades 6-8; and 1:15 for Grades 9-12 neete trips) or 1:10 et trips’
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Applicant Signature
Administrator's Signature
Recommended [ ] Not Recommended
far Recommended [] Not Recommended
Board of Education (¢ applicable)
Board of Education Meeting Date: a Recommended fe Not Recommended
Bus Information
Bus Reservation Date: Price of Bus(es): $
*If a trip to a foreign country, please complete and attached the CIRMA insurance application and notify parents of coverage Last Updated 5/27/21
Field Trip Instructional Plan
Colchester Public Schools
Field Trip Locations): Bvoadwam. alt w. Ya*4 St Nu Yole ,wY
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Reference Check: Visited site on: or Spoke with: ~ lash Dowon.
Nase, YN Goodwin Grade/Group: Bt Bund (Chars
(Teacher(s) completing this form)
Instructional Focus of Trip
¢ This field trip is directly related to curriculum Yes C] No
¢ Curriculum Unit(s): Unit 13 Concert Exerperiences
e Specific Curriculum Standards Addressed by Field Trip (please refer to CT Core and disciplinary standards):
PR4.1.E.51, Pr4.2.E.8a
e Assessment of Student Learning (describe or attach the work students will complete upon their return to
convey the learning):
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Trip Agenda/Activities: List/attach entire break out of times for each day. Include travel time and all activities.
Attach additional sheet if needed.
DATE/TIME LOCATION ACTIVITY
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Approvals: ( Goodin : 16 5/23, Approved | |oenied
Department Chair (High School Only) Date
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Principal Date
Be roved Denied
Assistant Superintendent Date P LI
Updated 3.7.2023
Field Trip Cost Form
Date(s) of Trip:
Event:
M&J Bus(es) ONLY
Number of Students: Estimated Hours for trip:
(Add 1 hour pre/post trip)
Number of Buses:
Per Student Calculations:
M&J Bus(es) ONLY Coach Bus(es) ONLY
Admission per student:
Miscellaneous Fees per student:
Total admission and miscellaneous fees:
Cost of Bus
Total Field Trip *Cost per Student:
Additional Costs:
Number of Substitute Veachers
Rate per Day
Special Education costs n/a
Cost Associated if Nursing Required pg
Total *Cost to District:
Total *Cost of Trip:
Alternate funding for trip provided by: Music Activity Fund
*Insert these costs on the accompanying Field Trip Application f dated $2721
‘orm updated 5.27.