Policy EIA - Exhibit 1: Student Overnight Travel Application

Student Overnight Travel

Juab School District

Using this form:

Coaches or advisors should complete this form at least one week prior to the upcoming board meeting.
Share the form with the Athletic Director, who will gather the principal's signature and verify details.
The Athletic Director then Shares the form with district Human Resources to be approved by the Board of Education.

Application for Student Overnight and/or Extended Trip
Group requesting trip:
Head Coach/Advisor responsible
Cell #
# of students in the group	Female:
	Male:
	Total:
Dates of Trip
School days missed
Mode of Transportation
Destination
Objective of Trip
Total cost to each student	$
Amount to be paid by the school	$

Student Overnight Travel

Juab School District

Parent Meeting to Discuss Extended Out of State Trip Plans *This portion needs to be completed only for extended out-of-state trips. (To be completed by the principal after parent meeting is held.)
Date
Time
Place
# of students represented at the meeting by at least one parent
Preliminary vote through a confidential ballot (if the trip is an extended out-of-state excursion).	# of parents approving the trip:
	# of parents opposing the trip:

Student Overnight Travel

Juab School District

Cost
Cost per student for transportation	$
Cost per student for lodging	$
Cost per student for meals	$
Registration cost per student	$
Other expenses per student (must be listed on fee schedule)	$
Total cost per student	$
# of program advisors
Program cost per advisor	$
# of non-program chaperones required
District cost per chaperone	$
How will additional funds for the trip be raised?

Student Overnight Travel

Juab School District

School Certification and Approval

We have planned the above-proposed trip within the District Guidelines.


Faculty/Advisor Signature	Date


Principal Signature	Date


Board Approval	Date