IJOAA-E: REQUEST TO THE SCHOOL COMMITTEE FOR OVERNIGHT
AND OUT OF STATE TRIP
AUTHORIZATION
THIS REQUEST MUST BE APPROVED BY THE SCHOOL COMMITTEE
PRIOR TO PUBLICATION OF THE TRIP AND COLLECTION OF
MONEY
SCHOOL
Name of Trip/Event Coordinator
(s)
1.
Today's date
2. Name,
location and description of trip/event (Include name of sponsoring organization if other than a school-sponsored student
group)
Attach ten (10) copies of all the literature (letters,
flyers, brochures, etc.) that will be sent to
parents and/or distributed to
students regarding the trip/event
3.
Date(s) of the Trip/Event for which School Committee
authorization is being sought
4.
Explain how this activity supports the mission of the
school, the curriculum and/or the goals of the student
organization
5.
Estimated number of students who will participate in the
trip
6.
List Chaperones - Staff and Parents
7.
Financial Information
7a. Cost per
student $ X # of students =
$
7b. Cost of
Program $ Cost of Transportation
$
7c. Cost
per Chaperone $ Cost paid by Chaperone
$
7d.
Chaperone cost included in student fee? Yes No
7e.
Identify fund raising used to lower cost per student or subsidize student
fees
7f. How
much money do you anticipate raising to offset the cost to
students?
7g.
Identify any other costs of participating in this trip/program, e.g.,
extras,
optional activities, etc.
7h. Are all
meals, including those while in transit, included in the per student
fee?
(If no, identify) Yes No
8. Explain
the cancellation and refund policy
Additional
Information
Principal's
Approval
Signature
Date
Superintendent's
Approval Signature
Date
SOURCE:
Georgetown
Adopted on: April 24,
2008