Bemidji Regional Interdistrict Council

Bagley                                                           P.O. Box 974                                        Kelliher
Blackduck                                                1615 NW 5th Street                                   Lake of the Woods
Cass Lake-Bena                                    Bemidji Minnesota 56601                              Laporte
Clearbrook/Gonvick                                 Phone 218-751-6622                                 Littlefork-Big Falls
South Koochiching                                      Fax 218-751-6625                                  Mahnomen
                                                             Denny P. Ulmer, Director                               Waubun
                                                                                                                                           

                                                                FIELD TRIP REQUEST

Teacher Name:                                                                         Site:

Date of Field Trip:                                                                     Destination:

Transportation Arrangements (vehicles, drivers, paraprofessionals):

Meal Arrangements:

Estimated Cost (tickets, materials, etc. Submit costs on BRIC requisition form):

List learning concepts to be introduced/reinforced by this activity (how does this relate to the student's IEP?)

Parent Permission Obtained (list date/method):

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Approved:                                               Not Approved:                              
Coordinator:                                            Date:                                             
Director:                                                  Date:                                             

7/05

                    Comprehensive Special Education Services for North Central Minnesota Schools