A request confirmation page follows submission of this form.
It has instructions for procedure.

BOCES Charges
- $50 Connection fee per field trip
- Additional charges may apply depending on field trip
(Charges vary upon content provider)

If you have any questions, contact Robin Masters at OHM BOCES - 793-8587.
Submitting Request:
New Request  Revised/Resubmitted Request
Teacher Name: 
School: 
District: 
Grade(s): 
K 1 2 3 4 5

6
7 8 9 10 11 12

Special Needs 
Number of Students: 
Teacher Email: 
Mandatory - Connection & cost information will be sent by email reply to this request. 
Phone: 
Content Provider: 
Program Title: 
Proposed Dates & Times: 
1.
2.
3.



After Submitting, please review entries on Request Confirmation page.

To make changes after reviewing entries on Confirmation Page:

- Click Back button in upper, left corner of browser, 
which will hold your original entries.
"Return to the form" link will not hold original entries. 

- Make changes.

- Click Submit button.

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