MNPS Field Trip Request Form

NOTE: TSSAA sanctioned trips do not require a field trip form; however you MUST submit a bus request and requisition to pay the cost for the trip in advance. See your school bookkeeper for details.

This typedform must be submitted to the district officeat least one month in advance, as per DSOP 6.151, for all trips involving MNPS students and staff no matter the destination, date, or time of trip. Attach a very specific itinerary for out of county and overnight trips. If any information is missing, the complete package will be returned.

School: LockelandMNPS Sponsor Name and Title: Julie Sharp- 205-410-0190

This trip is: Co-curricularExtra-curricularIs this an athletic trip? Yes No

Departure Day/Date/Time: 11/11/2011Return Day/Date/Time: 11/11 /2011

Purpose of trip (be specific):To visit Tennessee’s oldest and largest underground classroom! Our “Day at the Cave” includes 6 unique educational programs designed to both excite and inform students about the wonders of the underground. Each program includes a fully guided tour of a lighted developed area of Cumberland Caverns where students will learn about the fascinating geology, unique history (Civil War artifacts) and wildlife that inhabits the cave. The students will learn about various cave formations while observing how the water cycle and rock cycle combined to create the caverns!! Students will also mine for fossils!!

Overnight trip: NoYes (If yes,a complete typed itinerary must be attached, including lodging quote)

Location(s):Cumberland CavernsCity: McMinnvilleState: TN Zip: 37110Contact Phone: 931-668-4396

Check one: In-county Out-of-county Out-of-state Out-of-country

Name of group attending: Lockeland

Number of: Students 58*MNPS Employees4 *Parent Chaperones10 *Other Chaperones 0

*A list of all employees, parents and other chaperones must be attached. Teacher/Sponsor signature indicates that all chaperones have had the proper background check and have been approved. If not completed prior to the trip, they are not allowed on the trip.

Lunch Option: Sack lunches needed Lunch provided at site School lunch not affected

MNPS buses be used: Yes No If “NO” list transportation carrier: Gray LineAND Insurance provider: Acord

(Attach quote)

Cost of transportation: n/aOther Expenses: n/aTotal Cost: $1,160.00

What funds will be used to cover the costs for this trip? (Be specific): field trip fundCost per Student: $20.00

Once approved, the tier level secretary at the district office will notify the transportation department via fax if a reservation is needed for a Metro bus. Your bus request must be attached to this request. Transportation will contact the teacher with confirmation of the bus reservation.

ADA needs (adult or student) BusOther (Provide details):

Will a school nurse be required? No Yes If yes, the school nurse will be notified by the tier level secretary at the district office (615-340-7792).

(Requisitions for purchase orders must be completed PRIOR to any reservations or bookings per DSOP FM2.103, but Purchase Orders are not to be issued prior to approval by the district office.)

FIELD TRIP CRITERIA/SIGNATURE PAGE

Please address the following questions Request Form and return to the appropriate Executive Director.

  1. What academic state standards are enhanced through this field trip? (Standard number and description) If this is an extra-curricular trip, describe the benefit to students who attend. Earth Science- Conceptual strand 7- Major geological events over eons or brief moments in time continually shape and reshape the surface of the Earth, resulting in continuous global change. Study of the water cycle (SPI 0407.8.1), Causes/Effects of physical changes in matter (SPI 0407.9.3), and rocks and minerals (0407.7.1)
  2. What specific activities will the students complete as follow-up to the field trip? GLE 0407.7.1 Prepare a demonstration to show how wind and water affect the Earth’s surface/Rock and Mineral project (metamorphic, igneous, sedimentary)
  1. What group or groups of students were selected for the field trip? 4th grade
  1. What criteria were used to exclude students from the field trip?n/a
  1. What arrangements (lesson plans, substitutes, etc.) have been approved for coverage of classes and credit for students who will remain at school while you are out? All students will be able to attend.
  1. How is the total cost of the trip, including transportation (MNPS bus or other), to be paid? By students
  1. If there is a cost per student, how is this cost covered for students who do not pay?

We have a payment plan set up, as well as, funds to cover students who are not able to pay.

  1. Please check all that safety measures that apply:

Sufficient numbers of chaperones are available for the number of students

Appropriate clothing/goggles, etc. Buddy system School contact information on-hand

First Aid Kit Emergency contact/medical information on-hand for students

Other:

  1. How much academic time will be spent away from the building? How long is the trip overall?

7:00 a.m. to 3:30 p.m.

  1. If field trip approval was not submitted 30 days in advance to the appropriate Executive Director/Lead Principal, please provide an explanation.

______

School Cafeteria Manager SignatureDate

______

Bookkeeper Signature Date

______

Teacher Sponsor Signature Date (request submitted to principal)

______

Principal Signature Date

______

Lead Principal/Executive Director Signature Date (of approval)

______

Associate Superintendent Signature Date (of approval)

Field Trip Worksheet

Transportation Department Fax: 615-291-6325Revised July 13, 2011

Transportation Costs

Transportation Department Fax: 615-291-6325Revised July 13, 2011

Driver

  • MNPS Bus for field trips: $120 for the first 3 hours, $33 per hour for each hour over 3 hours
  • MNPS Bus for Band and Athletic events is $161 for 5 hours*, $33 per hour for each hour over 3 hours
  • *If less than 5 hours are needed, the lesser of the two amounts will be charged based on hours needed

Mileage

  • Up to 85 miles, no charge
  • Over 85 miles, $0.46 per mile

Cancellation

  • $50 fee for each bus cancelled

Transportation Department Fax: 615-291-6325Revised July 13, 2011

Event

Transportation Department Fax: 615-291-6325Revised July 13, 2011

  • Fees (contest fees, group fees, etc.)
  • Admission per person x number of people
  • Lodging, if overnight
  • Other (any costs that must be paid for the trip)

Transportation Department Fax: 615-291-6325Revised July 13, 2011

Total Costs

MNPS Bus : Flat Fee (either $120 or $161)

Additional hours x =

Other Approved Transportation: Total Cost per Quote

(must be attached to field trip request)

Event:Fees

Admission per person x # of people$928.00

Lodging Quote:

(must be attached)

Other (specify): $2 snacks for trip$4.00

$2 funds to cover those students who

cannot payTotal: $1160.00

Costs paid by other than students (specify): -

Total paid by students: 20.00

Total per student (total paid by students/number of students):20.00/58

Checklist

Request is complete

Complete list of chaperones is attached (note any who are completing the approval process)

Bus transportation request OR Non-MNPS transportation quote is attached

Will be submitted in time for principal to get to central office at least 30 days in advance

If overnight, quote for lodging is attached

If overnight, complete itinerary is attached

Requisition for purchase orders and teacher leave forms have been submitted(PO not to be issued until approved)

All signatures, including the cafeteria manager and bookkeeper are complete

Transportation Department Fax: 615-291-6325Revised July 13, 2011