Ittanowa Field Trip Program
This program is made possible by generous donors to the Chahta Foundation
Chahta Foundation
info@chahtafoundation.com | (580) 380-2667
School or Homeschool Group Name
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School District (If Applicable)
Organization Type
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Please Select
Public School
Private School
Tribal School
Homeschool Group/ Co-Op
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Primary Contact Information
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First Name
Last Name
Title
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Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
E-Mail Address
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example@example.com
Field Trip Details
Destination: Choctaw Cultural Center - 1919 Hina Hanta Way, Calera, OK 74730
Please provide a range of dates you would like to schedule - Top 3 Dates (MM/DD/YY). The Choctaw Cultural Center is open on weekdays Tuesday - Friday
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Grade Levels Attending
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Total Number of Chaperones Attending
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Total Number of Students Attending
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Total Number of Chaperones Attending
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Estimated number of students who are enrolled Choctaw Nation of Oklahoma Tribal Members
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Estimated number of chaperones who are enrolled Choctaw Nation of Oklahoma Tribal Members
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Funding Request
Please complete this section to help our team estimate cost and needs
Please indicate the support you are requesting (select all that apply)
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Student Admissions Support
Lunch Support
Acknowledgements
By submitting this application, the school agrees to submit final attendance numbers after the field trip.
Signature
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Name
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First Name
Last Name
Date
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-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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