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1363 Fulton Avenue
Bronx, New York 10456
Tele # (718) 9927089 – Fax # (718) 5901052
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 for
proper 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 permission
form template attached. Fill out the permission form completely and then
request for the permission form to be copied by Ms. GuzmanWilliams.
(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 was
not approved. You do have the option to resubmit a new proposal as long as
you have modified the request.
Check List
Field trip Proposal was submitted at least 3 weeks before the date of the
trip
Field trip Proposal form completely filled out with your signature (Item
15)
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 are
requesting NYC School busses
The Bronx Center for Science and Mathematics
1363 Fulton Avenue
Bronx, New York 10456
Tele # (718) 9927089 – Fax # (718) 5901052
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 Information
Name:______________________________________________
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 education
goal.
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
____
14. Cost per student
a. Transportation $ __________ Total cost of Chaperone $ __________
b. Admission $ __________ Total Cost of Field trip $ __________
c. Meals $ __________ Amount of other funds $ __________
d. Lodging $ __________ Source of funds: ______________________
e. Other $ __________ ___________________________________
Total cost/Student $ __________
All funds collected MUST be submitted to the school. All payments to outside organizations must
be made from the school’s bank account
15. I have made all arrangements for this field trip in keeping with the educational, financial,
administrative and Department of Education policies and regulations.
____________________________________________
Sponsoring Teacher’s Signature
** Return time, all trips must return in time for buses to be at their assigned schools afternoon route
Administrative use only
Assistant Principal: _____________________________________ ________Approved
_______ Not Approved
Reason:
___________________________________________________________________________________
___________________________________________________________________________________
__
Assistant Principal: _____________________________________ ________Approved
_______ Not Approved
Reason:
___________________________________________________________________________________
___________________________________________________________________________________
__