The Bronx Center for Science and Mathematics
1363 Fulton AvenueBronx, New York 10456 Tele # (718) 992-7089 – Fax # (718) 590-1052
Edward Tom,
Principal
Field Trip Proposal Instructions
Thank you for proposing a field trip to enhance our students’ learning experience.1. Field trip requests MUST be submitted at least 3 weeks in advance to allow forproper processing.
2.
Complete all applicable information on the attached form.3. Submit the completed form to Ms. Spencer either in person or in her mailbox.4. Your completed form will be returned to you (via your mailbox) within 72 hours of your request.
a.
If your proposal is
approved
, your form will have the BCSM permissionform template attached. Fill out the permission form completely and thenrequest for the permission form to be copied by Ms. Guzman-Williams.(Allow at least 48 hours for your copies to be processed.)
b.
If your proposal is
not approved
, please refer to the reason why the trip wasnot approved. You do have the option to resubmit a new proposal as long asyou have modified the request.
Check ListField trip Proposal was submitted at least 3 weeks before the date of thetripField trip Proposal form completely filled out with your signature (Item15)List of students’ names and grade level attached (Item 10)
Copy of your assessment/assignment attached (Item 13)Costs of the trip is completely filled out (Item 14)Submit the approved form to Ms. Molina or Ms. Quinones if you arerequesting NYC School busses
The Bronx Center for Science and Mathematics
1363 Fulton AvenueBronx, New York 10456 Tele # (718) 992-7089 – Fax # (718) 590-1052
Edward Tom,
Principal
Field Trip Proposal Form
1. Teacher _________________________________________________________________________2. Class/Club _______________________________________________________________________3. Date Request Submitted ___________________ 4. Date of Field Trip _________________5. Length of trip: Day Overnight *
(Please circle your choice)
6. Destination Name and Address____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 7. Time of Departure _______________________ 8. Return Time** _____________________9. Method of Transportation: NYC School bus Charter Bus NYC Subway*** NYC Bus***
(Please circle your choice)
*** Specify which train or bus will be used ___________________
10. Number of Students _____________________ 11. Number of Adults __________________
Attach a list of the students’ names and grade level
12. *Lodging arrangements: (complete only if this is an overnight trip)Name:______________________________________________Address: ________________________________________________________________________________________Phone: _____________________________________________ 13. Travel Company InformationName:______________________________________________Address: ________________________________________________________________________________________Phone: _____________________________________________Insured? Yes No
(Please circle your choice)
Copy of insurance provided? Yes No
(Please circle your choice)
12.
Describe the
Educational Goal of Trip________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________13.
Describe AND attach
the method you will use to measure/assess the achievement of the educationgoal.________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________14. Cost per studenta. Transportation $ __________ Total cost of Chaperone $ __________b. Admission $ __________ Total Cost of Field trip $ __________
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BCSM Field Trip Request Form
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| Upload Date: | 02/26/2009 |
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