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

EDUCATION RESERVATION REQUEST FORM

NPS Form 10-1750

OMB Control No 1024-0288

Expiration Date: XX/XX/20XX

SECTION 1: Contact Information (Required)
School/Organization Name
Name of Requester
Title/Position
School Contact Email Address
School Contact Phone Number
School Mailing Address
City
State	Zip Code
Is this reservation for a Title 1 school? Yes  No
Does anyone in your classroom require accommodation? Yes No
Describe the accommodation need:

SECTION 2: Group Details – Park Visit/ Field Trip
Name of Primary Contact (if different from Section 1)
Title/Position (if different from Section 1)
Primary Contact School Email Address (if different from Section 1)
Primary Contact Phone Number (if different from Section 1)
Program Name, Subject Requested, or Self-Guided Visit
Provide any learning goals or curriculum connections to help staff meet your needs
Additional info about your visit (location at park, onsite itinerary for visit, is the group staying for lunch?)
Grade	Number of Students	Number of Classrooms	Number of Adults (Chaperones/Teachers)
Preferred Day and Date of Visit		Preferred Program Start Time	Alternative Date(s)
Anticipated Arrival Time		Anticipated Departure Time	Mode of Transportation/Number of Vehicles
Disclaimer: A representative from the park will follow up to confirm details once this request has been reviewed.

SECTION 3: Group Details – Ranger-in-Classroom Program
Name of Primary Contact
Title/Position (if different from Section 1)
Primary Contact School Email Address (if different from Section 1)
Primary Contact Phone Number (if different from Section 1)
Program or Subject Requested
How much time will the ranger have to conduct the program?
Provide any learning goals or curriculum connections to help staff meet your needs
Grade	Number of Students	Number of Classrooms	Number of Adults (Chaperones/Teachers)
Preferred Day and Date of Program		Preferred Start Time	Alternative Date(s)
Disclaimer: A representative from the park will follow up to confirm details once this request has been reviewed.

SECTION 4: Group Details – Virtual/Distance Learning Program
Name of Primary Contact (if different from Section 1)
Title/Position (if different from Section 1)
Primary Contact School Email Address (if different from Section 1)
Primary Contact Phone Number (if different from Section 1)
Program or Subject Requested
How much time will the ranger have to conduct the program?
Provide any learning goals or curriculum connections to help staff meet your needs
Grade	Number of Students
Preferred Day and 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?
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: Internet Access Phone Access (speaker phone or conference line) Mobile or digital video conferencing capabilities Firewall Hardware and Software Capabilities Classroom pre-work or assignments

SECTION 5: Academic Fee Waiver
Visitors 16 years of age or older (including students, chaperones, and teachers) must pay an entrance fee at this site. Academic institutions (including schools) may use this section to apply for an academic fee waiver to cover the cost of these visitors. The number of teachers/chaperones that are covered with a waiver varies depending on the size of the group.
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: 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 or educational tax-exempt letter. If this is not available, describe the institution status below.
Criteria Two – Educational Purpose: Verify how this visit supports a specific curriculum for which academic credit is offered. For example, attach a course syllabus or description, course catalog, lesson plan, the education standard supported, letter detailing the educational purpose, etc., 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) or described if this is not available.
Name of Person Requesting Waiver	Title
Signature of Person Requesting Waiver	Date
Signature of NPS Fee Waiver Approver (for NPS use)	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 1024-0288

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, 13461 Sunrise Valley Drive, (MS-263) Herndon, VA 20191. Please do not send your form to this address.