Overnight Trip Request
We would like to kindly remind you of the importance of completing this form with as much detailed information as possible. Your thorough input is crucial to ensuring accurate and efficient processing. Unfortunately, incomplete form will not be processed at all.
School Information
School/Campus
*
Please Select
Bergen Primary
Bergen Elementary
Bergen Middle
Bergen High
Bronx Primary
Bronx Elementary
Hudson Elementary
Hudson Middle
Passaic Primary
Passaic Elementary
Passaic Middle
Passaic High
Passaic Clifton Primary
Passaic Clifton Elementary
Passaic Clifton Middle
Passaic Clifton High
Paterson Primary
Paterson Elementary
Paterson Middle
Paterson High
Paterson Silk City Primary
Full Name of Teacher Requesting Trip
*
Teacher Position
*
Grade and Sections Attending
*
Trip Details
Is this trip local or international?
*
Local
International
Departure Date
*
-
Month
-
Day
Year
Date
Return Date
*
-
Month
-
Day
Year
Date
Number of Nights
*
Destination
*
Total Number of Student Attending
*
Total Number of Staff Attending
*
Total Number of Chaperones Attending
*
Provide a brief description of the trip and purpose
*
Cost Information
Estimated Total Cost of the entire trip (Hotel, Food, Activity, etc.)
*
Estimated cost per student
*
Estimated cost per staff member:
*
Estimated cost per volunteer parent/guardian chaperone:
*
Breakdown
*
Rows
Amount per person
Total # of persons
Package
Accommodation - Staff
Accommodation - Student
Accommodation - Chaperone
Meals - Staff
Meals - Student
Meals - Chaperone
Transportation - Staff
Transportation - Student
Transportation - Chaperone
Admission Fees - Staff
Admission Fees - Student
Admission Fees - Chaperone
Other (please specify) - Staff
Other (please specify) - Student
Other (please specify) - Chaperone
Total Cost
*
How is this trip being funded?
*
Fundraising
Money Collection
How is this trip being funded?
*
Fundraising
Money Collection
FUNDRAISING: How much money has been or will be raised?
*
FUNDRAISING: Describe the different fundraising methods
*
MC: How much is being collected from the families per student?
*
Are you requesting subsidy from iLearn Schools Central Office?
*
No
Yes
What are you asking assistance for?
*
How much are you requesting?
*
Departure Information
Mode of Transportation
*
Air
Land
Name of Airline
*
Land
*
Yellow Bus
Coach Bus ((Please note that iLearn Schools will only fund the cost of the yellowschool bus, and the price difference for a coach bus will be the responsibility of the school.)
How many buses are you requesting (Yellow bus can accommodate up to 53 persons).
*
Departure Date & Time
*
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Departure Location
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Return Date & Time
*
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Return Location
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
How are you paying for the bus price difference?
*
Lodging Information
Date
*
-
Month
-
Day
Year
Date
Name of Place
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Proposed Itinerary
*
Rows
Date
Destination
Activities
Lodging
1
2
3
4
5
6
LIST OF STUDENT PARTICIPANTS
*
Rows
First & Last Name
First & Last Name
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
LIST OF STAFF CHAPERONES
*
Rows
First & Last Name
First & Last Name
1
2
3
4
5
6
7
8
9
10
LIST OF VOLUNTEER PARENT CHAPERONES
*
Rows
First & Last Name
First & Last Name
1
2
3
4
5
6
7
8
9
10
List of Students Who Require Medical Needs
*
Rows
First & Last Name
Type of Medical Need
1
2
3
4
5
6
7
8
9
10
Comment
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Name
*
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Email
*
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Date
*
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-
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Date
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