ISHAM PTOREQUEST FOR SCHOOL FIELD TRIP REIMBURSEMENT

Instructions: This form is to be completed by the requesting teacher(s) and submitted to the principal prior to the date of the field trip. The principal will review, sign and return the form to the teacher(s). If approved please submit a signed copy of the request form to the Isham PTO for review/vote at the next Isham PTO meeting.

FIELD TRIP INFORMATION – to be completed by the responsible teacher(s)

Reason for Trip

Mode of Transportation (Check all that apply)

Chartered Vehicle School/Activity Bus Walking Other: Specify

Transportation Cost = $Cost per Student = $

Total Cost = $

Scholarship Request for # of Students = (Additional Form Required )

Teacher Signature Date

Teacher Signature DatePrincipal Signature (Approval) Date

Please attach quotes and any other documentation related to this field trip that may assist in the reviewing process.

Special Note to Teachers: Field Trip Requests need to be submitted PRIOR to Date of Trip. Transportation Costs are covered by the Isham PTO Field Trip Fund. All non-transportation cost will need to be reviewed and voted on at the next Isham PTO meeting and will depend on availability of funds.

Teacher(s) have 30 days from the Date of Trip to submit receipts for reimbursement

Grade/Teacher Destination Date of Trip

Number of Student =

Justify Amount Here With Itemized Cost:

Isham PTO Use Only:

___ Approved ___ Declined Additional Information Requested: _____________________________________

Date of Approval _____________ Date of Reimbursement _______________ Check #____________