1. Request for Field Trip
    2. Recommended:
    3. Approved:

April 6, 2004 AA-1502.2A

 

 

AA-1502.2A April 6, 2004

 

 



Request for Field Trip

              Date of Request


Campus              Division/Department


Class/Section        Instructor


Purpose of Field Trip


Facility Visited


Address/Location


Date and Time         No. of Students


Mode of Transportation


Cost and Method of Payment

 

Other Information (If applicable)


 

 

 

 

 

I understand that I am required to obtain signed Student Field Trip Waivers for all students attending this field trip.

 

________________________________  _____________

Signature of Faculty Member      Date

 


Recommended:

 

_________________________________  ______________

Division Dean          Date

 


Approved:

 

______________________________________________  ______________

Vice Chancellor for Academic Affairs      Date

 

Form 1502/002 (6/12)

 

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