Field Trip Authorization
(Please Attach Your Absence
Record Form)
Person
Making Request:
________________________________________________________
Course/Organization:
__________________________________________________________
Planned
Number of Students Taking Trip:
_________________________________________
Nature
and Rationale of Trip:
___________________________________________________
____________________________________________________________________________
Names and social security numbers of students taking proposed trip:
(attach additional sheets if necessary)
Note: If activity meets at least one of the
following: (a)summer camp; (b) sports activity; (c) out of state field trip; or
(d) involves participants under the age of 18; or (e) it is not any of the
above, but exposes participants to a risk of injury that is not ordinarily
present in an academic setting (ex. Rock climbing trip, snot ski trip, or
carpentry workshop), please consult the Vice President of Student Services to
explore the need for Excess Medical Accidental Insurance purchase.
List
participants below:
____________________________________ ___________________________________
____________________________________ ___________________________________
____________________________________ ___________________________________
____________________________________ ___________________________________
____________________________________ ___________________________________
____________________________________ ___________________________________
____________________________________ ___________________________________
____________________________________ ___________________________________
____________________________________ ___________________________________
____________________________________ ___________________________________
____________________________________ ___________________________________
____________________________________ ___________________________________
____________________________________ ___________________________________
Date
and Hour of Proposed Trip: Expense
to College:
Departure
Date: ___/____/____ Hour_____ Travel:
_______________________
Return
Date: ___/_____/____ Hour ______ Meals: _______________________
Notes:
______________________________ Accommodations:
____________________
___________________________________ Total Expense: ___________________
Account:
___________________
Approved:
__________________________ Date:
______________________
Please
send copies to: Vice President of
Academic Affairs
Vice President of Student Services