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WEST SHORE SCHOOL DISTRICT
Major Trip Athletic and Student Activities Application
All areas are to be completed and answered in full. If more explanation is needed, provide an attached
sheet. Follow policy in working to determine if the trip is within guidelines. Make sure all signatures at the
building level are secured before sending the application to the Director of Secondary Education.
Print, type, or fill-out all information. Attach additional pages if needed.
Name of person(s) making the request
Date
Position
Name of School
Organization
Dates of the planned trip
Dates of last trip (if applicable)
Destination
Number of school days missed
Number of students going
Total cost per student for trip
$
How much of this cost will the student pay
$
ESTIMATED COSTS
Do the above costs include food?
Yes
$
No
Do the above costs include lodging?
Yes
$
No
Do the above costs include a registration fee?
Yes
$
No
Are there any additional costs (if yes, list them below)?
Yes
$
No
CHAPERONES
Professional Staff Member(s) – List each staff member below, n/a if non-applicable
Support Staff Member(s) – Lis
t each staff member below, n/a if non-applicable
Extra Duty Staff Member(s) – List each staff member below, n/a if non-applicable
Parent(s)/Volunteer(s)** – List each parent/volunteer below, n/a if non-applicable
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Total Number of Chaperones**
** Chaperones must be secured who meet the District’s Volunteer Guidelines. Chaperones
that do not have the proper clearances may not go on this trip. Check with your principal.
Also, make sure that you have a sufficient number of chaperones as per District guidelines.
Major Athletic and Student Activity Trip Eligibility
P
lease Initial:
As per the revised Major Trip Guidelines, all students will be checked for eligibility
in compliance with the PIAA Constitution and By-Laws for High School Athletic
Eligibility. This includes athletic and non-athletic trips.
Trip Plans and Educational Focus
Purpose of Trip (What do you hope to gain by taking this trip? How will this help your students
and what will they learn/gain)?
Attach an itinerary of what will be done on this trip. Include departure times and return times
and the schedule of events in which the students/organization will be involved. A complete
listing of how the time is to be spent while away from school must be included. If there is “free
time”, it may be listed as such. This early in the process it is understood that these may change,
but provide as much detail as possible.
How will the success of the trip be evaluated? (This should come out of and be directly related to
the purpose for going. Example: As a result of this trip my students will be able to…. (or) As a
result of this trip the students will gain …)
A
dditional Logistical Information
How is this trip being funded? (Who is covering the cost for the student)?
If students are paying all or part of the cost, how are they funding this trip?
If another organization is funding this trip, please provide the name and describe the extent to
which they are covering this cost.
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If this is a major trip that requires an overnight stay, where will the students be staying?
How are you going to travel? (bus (district or charter), van (district or charter), plain, train, private
car).
If approved by the Board, are there any reasons, short of an emergency that you would
choose to cancel this trip? (please explain)
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Major Trip Athletic and Student Activities
Approval Page
Signature - person requesting trip
Date
Approve
Signature - Student Activities/Athletic Director
Date
Disapprove
Approve
Signature - Building Administrator
Date
Disapprove
Adm
inistrator, please provide reasons supporting your decision:
ADMINISTRATION USE ONLY
Approve
Date
Disapprove
Signature - Director of Secondary Education
Approve
Signature – Assistant Superintendent Date Disapprove
Approve
Signature – Superintendent Date Disapprove
Board Notification Date
