2017-18 ONLINE Overnight and/or Out of State Trip Request Form

Overnight and/or Out of State Trip Request

Clark County Public Schools
Submission Date

MonthDayYearHourMinutesAM/PM Option
Board Meeting Date*

MonthDayYear
Date Approved By SBDM*

MonthDayYear
Administrator Making Overnight/Out of State Request:*

First NameLast Name
Administrator's E-mail Address:*
Your E-mail Address
School/Department:*
Overnight/Out of State Agenda Item Request: *
Organization:*
Grade, Team, Club
Teacher/Coach/Sponsor:*

First NameLast Name
Teacher/Coach/Sponsor Contact Number:

Area CodePhone Number
Teacher/Coach/Sponsor's E-mail Address*
CHECK ALL THAT APPLIES:*

Out of StateOvernightIn State
Departure Date:*

MonthDayYear
Departure Time:*

:HourMinutesAM/PM Option
Departure Location:*
Return Date:*

MonthDayYear
Return Time: *

:HourMinutesAM/PM Option
Return Location:*
Purpose of Trip:*
Upload Itinerary

Upload a File
If Applicable Cancelof
Transportation Plans:*
How will students be transported?
Funding Source:*
If "Other" indicate here:
Number of Students:*
How many days of school will be missed?*
Number of Parent Chaperones:*
Number of Staff Chaperones: *
Cost Per Student:*
Total Trip Cost :*
Including this trip, what is the total number of trip request submitted by your organization this school year?*
An E-mail will automatically be sent to Central Office and you will receive a confirmation E-mail once the "Submit" button is selected.
RELATED PROCEDURES:
09.36 AP.211, 0936 AP.212, 09.36 AP.23 REVIEW/REVISED:3/16/10
Should be Empty: