Form NPS 10-1750 NPS 10-1750 Education Reservation Request Form

NPS Form 10-1750 (04/2021)
National Park Service

OMB Control No. 1024-NEW
Expiration Date: ##/##/####

EDUCATION RESERVATION REQUEST FORM
[Park/Area Name]
[Park Mailing Address]
[City, State, Zip Code]

SECTION 1: Contact Information (Required)
School/Organization Name
Name of Requester
Title/Position (optional)
School Contact Email Address
School Contact Phone Number
School Mailing Address
City
State
Zip Code
Does anyone in your classroom need any accommodations? Yes

No

Describe need:

SECTION 2: Group Details – Park Visit/ Field Trip
Day of Event – Name of Primary Contact
Title/Position
Primary Contact School Email Address
Primary Contact Phone Number
Program or Subject Requested/Self-Guided

Grade

Number of Students

Number of Chaperones

Preferred Date of Visit

Preferred Program Start Time

Alternative Date(s)

Anticipated Arrival Time

Anticipated Departure Time

Mode of Transportation

Disclaimer: A park representative will follow-up to confirm group details once this request has been
received and reviewed.

NPS Form 10-### (04/2021)
National Park Service

OMB Control No. 1024-NEW
Expiration Date: ##/##/####

SECTION 3: Group Details – Ranger-in-classroom Program
Day of Event – Name of Primary Contact
Title/Position
Primary Contact School Email Address
Primary Contact Phone Number
Program or Subject Requested
How much time will the ranger have to conduct the program?

Grade

Number of Students

Number of Chaperones

Preferred Date of Program

Preferred Program Start Time

Alternative Date(s)

Disclaimer: A park representative will follow-up to confirm group details once this request has been

received and reviewed.

SECTION 4: Group Details – Virtual/Distance Learning Program
Day of Event – Name of Primary Contact
Title/Position
Primary Contact School Email Address
Primary Contact Phone Number
Program or Subject Requested

Grade

Number of Students

Preferred Date of Program

Alternative Date(s)

Preferred Program Start Time

Time Zone of Classroom

How much time will the ranger have to conduct the program?

NPS Form 10-### (04/2021)
National Park Service

OMB Control No. 1024-NEW
Expiration Date: ##/##/####

Virtual and/or Distance Learning can vary depending on the technical capabilities of the park and the school. in
order to find appropriate accommodations for your learning experience, here are some categories to be prepared
to discuss with the park:
(1) Internet Access
(2) Phone Access (speaker phone or conference line)
(3) Mobile or digital video conferencing capabilities
(4) Firewall
(5) Hardware and Software Capabilities
(6) Classroom pre-work or assignments

SECTION 5: Academic Fee Waiver
Only student 17 years of age or older years visiting a park that collects fees require Academic Fee Waiver

CERTIFICATION
Academic fee waivers are not granted automatically. Applicant groups must show they qualify for the waiver. There
are three criteria the group must meet to qualify for an academic fee waiver: eligibility, relevance of park resources
or facilities to academic program, and academic purpose. Details of these qualifications are listed below. If your
institution and purpose meet these criteria, submit the following form to the above address.
Criteria One – Eligibility: Describe below and/or attach current official recognition or accreditation as an
educational institution by a federal, state, or local government or other documentation attesting to educational
status, such as an accreditation letter, educational tax-exempt letter.
Criteria Two – Educational Purpose: Verify how this visit supports a specific curriculum for which academic
credit is offered. For example, attach a course syllabus/description, course catalog, lesson plan, letter detailing the
educational purpose, etc., and/or describe below.
Criteria Three – Relevance of Park Resources or Facilities: Identify the pertinent park resources and/or
facilities and detail how they are relevant to support the educational purpose of the visit (attach letter or describe
below):
Acknowledgement: I understand the Recreation Fee Authority (16 USC 6802 Sections 3 a and b) allows for fee
waivers only for bona fide educational and/or scientific institutions that are using the park for educational purposes.
I hereby certify that the above detailed trip meets these requirements and therefore request that fees be waived.
Current official documentation of recognition of affiliation as an educational institution by a Federal, State or local
government entity, or other evidence attesting to educational status is attached (e. g accreditation letter,
educational tax- exempt letter). It is insufficient to merely state or imply this on official letterhead.

Authorized Name

Title

Authorized Signature

Date

NPS Form 10-1750 (04/2021)
National Park Service

OMB Control No. 1024-NEW
Expiration Date: ##/##/####

NOTICES
PRIVACY ACT STATEMENT
Authority: Public Law 114 – 289 National Park Service Centennial Act and 54 U.S.C. 100701 Protection, interpretation, and research
in System.
Purpose: To administer education programs for education audiences including but not limited to school groups, scouting groups,
extracurricular groups, and home school groups.
Routine Uses: To effectively manage requests for education received by the NPS, the Education Reservation Request Form is used to
collect basic education reservation information to facilitate operational aspects of scheduling groups for park education programs,
including in-park education programs, ranger in classroom programs, and/or online distance learning programs.
Disclosure: Voluntary, however, failure to provide the requested information may impede the ability to grant your education reservation
request.
PAPERWORK REDUCTION ACT STATEMENT
We are collecting this information subject to the Paperwork Reduction Act (44 U.S.C. 3501) to provide park managers and educators
the information needed to schedule and conduct education program activities. All applicable parts of the form must be completed in
order for your request to be considered. You are not required to respond to this or any other Federal agency-sponsored information
collection unless it displays a currently valid OMB control number. OMB has approved this collection of information and assigned
control number 1024-NEW

ESTIMATED BURDEN STATEMENT
Public reporting for this collection of information is estimated to average 5 minutes per response, including the time for
reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and
reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of
information, including suggestions for reducing this burden, to the Information Collection Clearance Officer, National Park
Service, 1201 Oakridge Drive, Fort Collins, CO 80525. Do not send your completed form to this address.