Berlin Central School District

Videoconference/Virtual Field Trip Request Form

 The process to secure a videoconference/virtual field trip for your classroom includes completing this Request Form.  Once you find a videoconference that correlates and aligns with your grade specific curriculum, complete this form in writing or electronically and send it to Eileen Leffler.  Your request will be reviewed for approval based on curricular congruence, equity of offerings across the grade levels and buildings and available funds.  Once the request is approved, Lauren Nichols will contact the Content Provider with your preferred dates and times.  The requesting teacher and the videoconference points of contact support staff will be contacted as soon as the videoconference is scheduled.  Points of contact and videoconference support staff by building are; Tammy Osterhout – BES, Sue DiNova-GES, Eileen Roder – SES, Tammy Dunlop – MS, and Anne Hayes – HS.

Database of Video Conference Programs

Program Title: ________________________________________________

 

Requested by: _________________________________      Date: __________

 

 

Grade(s) & total number of students: _____________________________

 

Content Provider: _____________________________________________

 

Cost: ________________________________________________________

 

Preferred dates & times (at least 3 possibilities):____________________

 

_____________________________________________________________

 

Grade specific curriculum connections: ___________________________

 

_____________________________________________________________

 

Administrative Approval: _______________________________________

 

Date & Time of scheduled videoconference: ________________________