This form is used to identify and obtain advance approval for anticipated field experiences during the academic year. Dates, student participation, and other logistical details are estimates and may be adjusted as course schedules are finalized.
Department or Program *
Conservation Science & Wildlife ManagementEnvironmental Science & TechnologyGeologyDepartment-Wide
Course Title *
Course Number *
Section Number(s)
Academic Term(s) *
Select all terms in which this field experience may occur.
FallSpringSummer
Estimated Number of Students Participating *
Purpose of Trip * Please provide a brief explanation of how this field experience supports course objectives.
Location *
If a specific designation or location name is not appropriate, provide approximate GPS information.
Approximate GPS Information, if needed
Estimated Date Range *
Provide the anticipated date range for planning purposes. Exact field trip dates are not required and may change.
Earliest Anticipated Date *
Latest Anticipated Date *
Estimated Trip Duration (hours) *
Lead Instructor Name *
Lead Instructor ACC Email *
Emergency Contact Phone *
Lead Instructor CPR/First Aid
CPR/First Aid Complete
Support Faculty Name (if anticipated)
Support Faculty Emergency Contact Phone
Support Faculty CPR/First Aid
Technician Name (if anticipated)
Technician Emergency Contact Phone
Technician CPR/First Aid
Student Waiver Requirement *
I understand that all participating students must complete the required waiver prior to participating in the field experience.
Are students under the age of 18 anticipated to participate? *
YesNoUnknown at this time
Students under the age of 18 require the signature of a parent or guardian on applicable waiver forms.
Anticipated Mode of Transportation
Check all that may apply.
Rental VehiclePublic TransportationPersonal VehiclesWalkingWatercraftAirline/AirplaneOther
If Other, please specify:
If transportation other than personal vehicles is anticipated, is the mode of transportation expected to be ADA accessible?
YesNoNot ApplicableUnknown at this time
1. Is the destination on the department's list of pre-approved locations? *
YesNoUnsure
Refer to the department's list of pre-approved locations and activities.
2. If the destination is not on the pre-approved list, is this a site or location where department faculty have taken students in the past?
YesNoNot ApplicableUnsure
Locations that are not pre-approved require a risk assessment prior to approval.
Anticipated Field Activities *
Check all activities that may be conducted during this field experience.
Guided HikeDay HikingNight HikingPhotography (no drones)FroggingInsect CollectingWater SamplingTrail MaintenanceSolo HikingSelf-GuidedCamera TrappingBoatingDivingSnorkelingHandling WildlifeOther
If Other, describe the anticipated activity:
Risk Assessment Review *
I have reviewed the applicable departmental risk assessment and confirmed that the anticipated activities are approved for this location, or I have identified activities or locations requiring additional review.
Provide estimated costs for annual planning purposes. Enter amounts only for expenses that are anticipated.
Vehicle Rental ($)
Parking ($)
Fuel ($)
Use or Entrance Fees ($)
Meals ($)
Room Accommodations, if applicable ($)
Supplies / Other ($)
Description of Supplies / Other Expenses
Estimated Total Cost ($)
I certify that I will supervise participating students and ensure compliance with applicable college policies and departmental field experience requirements. I understand that the dates, number of participants, transportation arrangements, and estimated expenses provided on this form are for planning purposes and may change as course schedules and field experience arrangements are finalized.
I certify that the information provided in this request is accurate to the best of my knowledge and agree to the statement above.
Instructor / Trip Leader Name *
Date of Submission *
