Form 1-7150 - Request For Approval Of Field Trip
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1BERKELEY UNIFIED SCHOOL DISTRICT
REQUEST FOR APPROVAL OF FIELD TRIP
All requests for field trips should be received by the Principal at least THREE WEEKS in advance of the trip.
TO:
Principal/Designee
SCHOOL: _______________________
DATE OF REQUEST: ________________
FROM:
______________________________________________________
ORGANIZATION: ___________________
DATE OF FIELD TRIP: ________________________
DESTINATION: ________________________________________
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Check if field trip is over 12 hours or overnight - Attach Overnight form.
Roundtrip mileage: __________________
Time of departure load at school: ___________________
Approx. time return to school: _______________________
Mode of transportation: ________________________________________________________________________________
If arrival back to the school site is beyond normal dismissal time, what arrangements will be made for transportation to students’
homes? _____________________________________________________________________________________
Means of financing trip: ________________________________________________________
Cost: _________________
What contacts have been made with the place the group is visiting? _____________________________________________
___________________________________________________________________________________________________
What is the educational value or purpose of this field trip? _____________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
What classes or which students will be participating? _________________________________________________________
___________________________________________________________________________________________________
Number going on trip - Students: _____________ Certificated employees: ____________ Other adults: ______________
What classes or other duties will each supervising teacher miss and who will cover them? (It would be appropriate to note here
who will be supervising students not going on the trip.)
Teacher
Classes/Duties meeting coverage
How will coverage be provided?
_____________________ ________________________________
_______________________________________
_____________________ ________________________________
_______________________________________
_____________________ ________________________________
_______________________________________
How will appropriate staff be notified of excused students?
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Roster distributed 2-days in advance of the trip
Other ________________________________
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Student field trip passes signed 2-days in advance of the trip
_____________________________________________
__________________________________________
Signature of Supervising Certificated Staff Member in Charge
Signature of Department Chair (if any)
Permission Granted:
Permission Denied:
________________________________ ______________
_______________________________ ___________
Principal / Designee
Date
Principal / Designee
Date
Field trips using private vehicles (exceptional circumstances only), over twelve hours in length or overnight must have the
approval of the Superintendent/Designee.
Permission Granted:
Permission Denied:
________________________________ _____________
_______________________________ ___________
Assist. Supt., Ed. Services/ Designee
Date
Assist. Supt., Ed. Services/ Designee
Date
Distribution / Copy: Certificated Staff Member in Charge, Principal/Designee, Director of Curriculum & Instruction/Designee, Transportation
Form 1-7150 6/04
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