EL PASO COMMUNITY COLLEGE REQUEST FOR FIELD TRIP **FIELD TRIPS CAN PLAY AN IMPORTANT ROLE IN THE INSTRUCTION PROCESS. FACULTY MEMBERS PLANNING FIELD TRIPS SHOULD SUBMIT “REQUEST FOR FIELD TRIP” TO THE DIVISION CHAIR TEN WORKING DAYS PRIOR TO THE SCHEDULED TRIP.** TO: Richard Webb Dean of Math, Science and Career & Technical Education FROM: (INSTRUCTOR’S NAME) DATE: DISCIPLINE DATE OF REQUEST DATE OF FIELD TRIP CLASS COURSE NUMBER & SECTION NUMBER FIELD TRIP DESTINATION GIVE A BRIEF DESCRIPTION OF FIELD TRIP IN RELATION TO THE COURSE OBJECTIVES: NUMBER OF STUDENTS EXPECTED TO PARTICIPATE IN FIELD TRIP: NO OF STUDENTS PARTICIPATING IN FIELD TRIP SOURCE OF FUNDS MODE OF TRANSPORTATION ESTIMATED ROUND TRIP MILEAGE INVOLVED APPROVED BY: (DIVISION CHAIR) DATE FIELD TRIP DISCLAIMER I HEREBY ACKNOWLEDGE THAT I AM SOLELY RESPONSIBLE FOR ALL CONSEQUENCES, WHILE TRAVELING TO (FIELD TRIP DESTINATION) WITH , ON (COURSE & SECTION) (DATE) FOR THE PERIOD COVERING (TIMES) THIS WAIVER INDICATES THAT I CANNOT HOLD THE INSTRUCTOR, CLUB OR CLUB SPONSOR OR REPRESENTATIVE, AND EL PASO COMMUNITY COLLEGE DISTRICT LIABLE IN CASE OF ACCIDENT OR INJURY TO MY PERSON AS A RESULT OF THE TRIP. STUDENT’S NAME 1 16 2 17 3 18 4 19 5 20 6 21 7 22 8 23 9 24 10 25 11 26 12 27 13 28 14 29 15 30 (WITNESS) (EPCC REPRESENTATIVE) (DATE) (DATE)