Application for Field Trip Transportation Funding

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Application for Field Trip Transportation Funding
Application for Field Trip
Transportation Funding
The funding awarded by this application provides at most $500 in
reimbursement or direct costs of transportation for educational trips to
Southern Nevada’s outdoor places. The funding is available to community
organizations and school groups that demonstrate need of assistance and
submit a description of their goals and purpose for planning a field trip.
The Outside Las Vegas Foundation (OLVF) promotes healthy education and
resources for communities in connection with outdoor learning opportunities
for young people. We envision a community that enjoys, values, and protects
Southern Nevada’s special outdoor places. If selected for this grant, your
organization will be asked to complete a report summarizing your
experience, how it benefits the wellbeing of your community and enhances
the public’s appreciation and understanding of Southern Nevada’s special
outdoor places.
1
Part I
Instructions
The Application Process
• Applications are accepted on a rolling basis.
• There are no limits on the number or frequency of submissions from a single
applicant, however new applicants will be given preference in the selection
process.
• Applications must be submitted no less than two weeks prior to the requested field trip date.
• Funding may not be applied to past field trips.
• All participants must sign OLVF’s waiver (attached) and are encouraged to consent to an image release prior to a field trip.
• Recipients will share photos and documentation of their trip with OLVF.
• OLVF requires at least one chaperone for every ten participants on a field trip.
• Applicants seeking reimbursement must be capable of submitting an invoice
and W-9 form to OLVF.
• CCSD teachers please refer to Appendix A at the end of this document.
Submitting your Application and Final Report
Keep this page for future reference. Completed applications and final reports may
be submitted by mail, fax, or by email to the following address. If submitting by fax,
please remember to include our area code with your request.
Outside Las Vegas Foundation
919 E. Bonneville Ave.
Las Vegas, NV 89101
tel: (702) 997-3350
fax: (702) 879-7922
[email protected]
2
Reimbursement
Recipients should consult with OLVF prior to securing transportation. Once
arrangements are finalized, recipients will retain all documents and receipts relating
to their trip in order to be eligible for reimbursement. Recipients should seek
transportation only through a bus agency that has been approved by the Clark
County School District. Recipients must submit an invoice and W-9 form1 to OLVF
for reimbursement. Recipients must submit all documentation, including an
evaluation report following their field trip, before receiving funding.
Direct Funding
For applications requesting direct funding, OLVF will coordinate transportation for
the trip. No funding will be awarded to the recipient. OLVF may communicate with
the host site, schedule transportation, and coordinate all details related to the trip.
Recipients will take an active role and work closely with OLVF during this process.
Complete all forms and answer all questions to the best of your ability, attaching
additional pages for extra space. All information must be current and verified to be
correct. Read and sign the final agreement, and be sure to obtain the signature of
your supervising official or school principal as verification of your application and
intent. Potential recipients should maintain contact with OLVF regarding the status of
their application. Recipients must provide details regarding the planning and
execution of their trip.
The attached evaluation form must be submitted to OLVF no later than two weeks
following your trip. Failure to submit an evaluation or final report will result in OLVF
withholding funds, and possibly denying funding for future applications.
1
CCSD teachers are not required to include a W-9 form, as OLVF has one on file for the
school district.
3
Part II
Required Information
Complete Name of School or Organization
Street Address:
City:
zip:
Submission Date (mm/dd/yyyy):
Point of Contact:
Name:
Phone:
work:
cell:
Email:
fax:
Number of Participants:
age / grade level:
Number of Chaperones:
This application is for:
Reimbursement
4
Direct Funding
Part III
Application Questions
Please complete all answers in 500 words or less.
Answers may be submitted on a separate page or as an attachment.
1 Describe your organization’s mission statement
2 Where do you plan to visit? How did you discover the
program / event / location you are planning to visit?
If you have a contact person at this site, please list their details below. Please
include a destination address if you have one confirmed.
5
3 Do you have a prospective month or date for this trip?
Is there a specific time when you are unable to schedule
a trip?
Consider the possibility of scheduling conflicts, and provide alternative dates
if possible.
4 What are your desired outcomes? How will you follow
up / introduce your experience to the community?
6
5 If your trip includes a volunteer or service learning component, briefly describe the action and how you will measure results.
(optional)
6 Provide other relevant details
Consider possible time constraints, and past experiences on field trips.
Please inform whether you will require special accomodations such as
wheelchair seating on a bus. List other sources of funding for your trip and
any restrictions or provisions on those funds.
7
Agreement
Approval of this application by the Outside Las Vegas Foundation (OLVF) creates
specific obligations on the part of the recipient, including but not limited to an understanding that: the awarding and amount of any funds shall be subject to the sole
discretion of OLVF; that recipients must submit a final evaluation report with all requested documentation, receipts, and an invoice and W-9 form before receiving funding from OLVF; that all applications and evaluation reports become the property of
OLVF, which retains the right to supply others with a description and materials related to your trip. OLVF, its employees, and affiliates shall assume no responsibility
or liability for claims of loss or damage of any kind of property, or for claims of injury to any person in connection with this funding. Recipients agree to comply with
all requirements of this application as described by the instructions included in this
document.
Applicant’s Signature
/
print name
date
Supervising Official’s or School Principal’s Signature
/
print name
date
8
Evaluation Report
A final report is due to OLVF no later than two weeks following your field trip. Your
report must include this completed form, and at least one page of additional material
about your trip - we ask that field trip organizers encourage participants to reflect on
their experience in writing, though pictures, drawings, paintings, or other creative
activities.
Please refer to the instructions for submitting completed reports.
location / program / event visited
date of field trip (mm/dd/yyyy):
number of people served:
age range / grade level(s):
% male:
% female:
race / ethnicity:
White / Caucasian
Hispanic / Latino
check all that apply
Black / African American
American Indian
Asian
White / not Hispanic
9
If your trip includes a service learning component:
In one or two paragraphs, describe the outcome of your actions as defined in
the application questionnaire:
If applicable, list the total number of volunteer hours spent
on your trip, and other metrics related to your action.
Also include any other measurable results.
10
Appendix A - For CCSD Teachers
Teachers are required to follow standard CCSD field trip requests and procedures,
including completion of the following forms. As the approval process for field trips
scheduled through the Clark County School District (CCSD) can take a minimum of 4
weeks to complete, the Outside Las Vegas Foundation (OLVF) suggests that teachers
submit the required forms as early as possible. All documents listed below must
travel on the field trip in the possession of the lead teacher. Do not forward
copies of the following documents to the Outside Las Vegas Foundation.
Required Forms for Teachers:
In addition to completing the following forms, teachers must prepare an itinerary and
a list of student names and numbers for the trip.
CCF-798 Field Trip Plans and Request for Approval of Principal
CCF-460 Out-of-District Student Activity Authorization
CCF-145 Out-of-District Travel Request
CCF-101 Employee Absence Request/Authorization
Forms for Students:
Teachers should include the following documents in a packet to be sent home with
participating students, along with a letter to parents, and the Outside Las Vegas Foundation’s image and liability release waiver.
CCF-455 Student Medical Permission Form
CCF-796 Field Trip Permit
Scheduling CCSD Transportation
CCSD transportation may be scheduled through interact - your office manager can
assist with your request. Field trips using CCSD transportation may depart no earlier
than 9:00 AM, and must return no later than 1:00 PM. Because of the serious time
limitations involved in scheduling CCSD busses, OLVF recommends applying for direct funding through a private bus agency. OLVF works from a list of agencies with
insurance approved by CCSD.
11
Reimbursement
OLVF can provide reimbursement for busses scheduled through CCSD. The individual school scheduling transportation will be responsible for coordinating the time and
length of service, and providing the initial funding. Once a final report has been prepared with all of the necessary documents, schools may then submit an invoice to
OLVF for the cost of transportation. OLVF has a W-9 for the school district on file.
12
Transit(and(Image Release
Release&Requirement&
&
Admittance*aboard*this*bus*requires*a*completed*release*form.*A*parent*or*legal*guardian*must*sign*the*release*for*
participants*under*the*age*of*18.&It*is*the*policy*of*The*Outside*Las*Vegas*Foundation*to*provide*for*the*safety*of*
participants*during*an*official*event*and*to*take*every*precaution*reasonable*to*ensure*that*transportation*provided*
at*our*expense*for*events*that*we*are*involved*with*is*run*with*due*regard*for*the*safety*of*all*participating*
individuals.*However,*engaging*in*any*form*of*transportation*involves*a*degree*of*risk,*and*boarding*this*bus*for*a*
field*trip*is*no*exception.**
*
*
General&Release&and&Save&Harmless&Waiver&
*
The*undersigned*does*hereby*assume*any*and*all*risks*involved*in*traveling*aboard*a*bus*as*offered*through*the*Outside*
Las*Vegas*Foundation*and*does*hereby*save*and*hold*harmless*the*above*organization*from*any*and*all*claims,*losses*and*
damages*(including*attorney’s*fees*and*any*costs*involved*because*of*said*claims),*on*account*of:*lost*or*damaged*articles;*
accident;*any*mishap*due*to*alcohol*or*drug*abuse;*death;*injury;*illness;*disruption;*delays*or*cancellations*caused*by*
weather*conditions;*any*mechanical*or*electrical*difficulties;*or*other*events*beyond*their*control.*__________**(please&initial)*
*
&
Image&Consent&and&Release&
*
The*undersigned*does*hereby*irrevocably*consent*that*all*photographs*of*below*named*participant*taken*during*the*
participant’s*time*attending*Outside*Las*Vegas*Foundation*events*by*staff*or*contractors*employed*by*Outside*Las*Vegas*
Foundation*may*be*used*and*reNused*by*the*Outside*Las*Vegas*Foundation*for*purposes*of*illustration,*display,*
publication,*and*any*other*nonNprofit*purpose.*I*understand*that*these*images*may*be*cropped,*edited*or*otherwise*
altered.*___________**(please&initial)*
*
*
My*signature*indicates*that*I*have*read*the*above*General&Release&and&Save&Harmless&Waiver,*I*fully*understand*its*
terms,*I*understand*that*I*have*given*up*rights*by*signing*below,*and*I*sign*freely*and*voluntarily*without*any*inducement.*
*
Additionally*my*signature*indicates*that*I*have*read*the*above*Image&Consent&and&Release,*I*fully*understand*its*terms,*I*
understand*that*I*have*given*up*rights*by*signing*below,*and*I*sign*freely*and*voluntarily*without*any*inducement.*
*
*
__________________________________________________************************______________________________________________________*
*******participant*(please*print)******************************************************participant*signature***************************date*
*
*
If&participant&is&under&the&age&of&18:&
&
**__________________________________________________*************************________________________________________________________*
******************parent*or*legal*guardian*(please*print)*********************************parent*or*legal*guardian*signature*******date*
Outside(Las(Vegas(Foundation(is(a(501©3(Organization((
For(further(information,(contact(Mauricia(Baca(at(702D715D0226(
Eximición(de(responsabilidad(para(el(traslado(y(para(la(divulgación(de(imágenes(((
Solicitud)de)Eximición)de)responsabilidad)para)traslado)
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El#acceso#a#este#ómnibus#requiere#la#presentación#de#un#formulario#de#autorización#completo.#Uno#de#los#padres#o#el#
tutor# debe# suscribir# la# autorización# para# los# menores# de# 18# años.# La# Fundación# Outside# Las# Vegas# tiene# como#
política# velar# por# la# seguridad# de# los# participantes# durante# un# evento# oficial# y# tomar# las# precauciones# necesarias#
para#asegurar#que#el#servicio#de#traslado#a#su#cargo#en#eventos#en#los#cuales#participa#se#lleven#a#cabo#de#manera#
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reclamos,# pérdidas# y# daños# y# perjuicios# (lo# cual# incluye# los# honorarios# de# los# abogados# y# los# gastos# que# surjan# de# esos#
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documento#durante#los#eventos.#Estas#fotografías#pueden#ser#utilizadas#y#reutilizadas#por#la#Fundación#Outside#Las#Vegas#
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__________________________________________________########################______________________________________________________#
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