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Colchester Public Schools
Application for Approval of Field Trip
O v e r v i e w : T h i s F o r m m u s t b e c o m p l e t e d b y all staff to r e q u e s t a p p r o v a l o f a F i e l d T r i p
Directions
1. C o m p l e t e t h e f o r m w i t h all a p p l i c a b l e d o c u m e n t a t i o n a n d s u b m i t t o y o u r D e p a r t m e n t H e a d ( B A o n l y ) a n d y o u r A d m i n i s t r a t o r .
T h e F o r m m u s t b e submitted at least 2 w e e k s prior to the Field Trip for In-State Trips a n d 1 O w e e k s prior to the Field Trip for Out-of-State Trips.
2 . If a p p r o v e d b y y o u r A d m i n i s t r a t o r , t h e f o r m m u s t b e s e n t t o t h e A s s i s t a n t S u p e r i n t e n d e n t f o r a p p r o v a l .
3 . if a p p r o v e d b y t h e A s s i s t a n t S u p e r i n t e n d e n t , t h e f o r m w i l l b e s e n t t o t h e S u p e r i n t e n d e n t f o r a p p r o v a l .
4 . lf t h e T r i p i s O u t - o f - S t a t e , it w i l l b e b r o u g h t t o t h e B o a r d o f E d u c a t i o n a t t h e i r n e x t s c h e d u l e d M e e t i n g f o r a p p r o v a l a n d f i n a l d e c i s i o n .
Instructional Focus
ls this Trip directly related to c u r r i c u l u m ? Yes No Curriculum Unit: Gr 6—8 Math
Field Trip Information
Applicant N a m e : A n d r e w Bakoledis Method of Transportation : Self-Transport
School : W i l l i a m J. J o h n s t o n Bus Service Number:
Grade(s) & Group(s) : Gr. 6 -8 N u m b e r of Students : 5
Date(s) of Trip : S u n F e b 16, 2 0 2 5 I N u m b e r of Day(s) of Trip : 1
EVeHti Eastern Reqional MathCounts Competition i
Destination : U C O H H Phone Number:
Destination Address: M C H u g h Hall, Hillside R d State: CT
Time of Departure from School : Clothing / Equipment Required :
T i m e of Arrival to School :
Student Cost Information
*Cost to Student Suggested Student Pocket Money $
$
$0 $ 2 0 for lunch
Supervision Information
1. N a m e i A m h O W R i Z Z i e ( U C O m e V e m C O O r d i n a t o r (‘iell P h o n e : anthony.rizzie@uconn.edu
2. N a m e : Stacy Ewinqs, AP WJJ l Cell P h o n e :
List all A d u l t C h a p e r o n e s : R a t i o o f a d u l t c h a p e r o n e s t o s t u d e n t s m u s t b e a t l e a s t : 1 : 5 f o r G r a d e s K - 2 ‘ 1 : 8 for G r a d e s 3 - 5 ,
1 : 1 0 for G r a d e s 6 - 8 a n d 1 : 1 5 for G r a d e s 9 - 1 2 (1 d a y trips) o r 1 : 1 0 (overnight trips)
s ta c Ewi n ¢ s
Administrato/r Signatures
‘ "/7/7/2
Applicant M”\«(//’27 Date 7"
Department Chair (BXOnly) Date Approved Denied
/
Principal/Administrator //\..; /f) § Date Z /’l/ZJ‘/ Approved Denied
Assistant Superintendent
(/ Date
/
Approved Denied
Superintendent Date Approved Denied
B o a r d o f E d u c a t i o n (if a p p l i c a b l e )
Board of Education Meeting Date Approved Denied
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Field Trip lnstructional Plan
Field Trip Location : U C o n n , M c H u g h Hall
Reference Check : Visited Site O n : OR S p o k e with:
N a m e of Staff Completing F o r m : Andrew Bakoiedis
Grade / Group Attending : Gr. 6—8
Instructional Focus of Field Trip
Specific Curriculum S t a n d a r d s A d d r e s s e d b y Field Trip:
Assessment of Student Learning:
Trip Agenda/Activities
L i s t / A t t a c h e n t i r e b r e a k o u t o f t i m e s f o r e a c h d a y . I n c l u d e t r a v e l t i m e a n d all activities
Date/Time Locadon Activity
2/16 9 a m M c H u g h Hall Math Competition
Bus information
Bus Reservation Date Price of Bus(es) $
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