ISTITUTO COMPRENSIVO STATALE
“LAVELLO I”
Scuola dell’Infanzia, Primaria e Secondaria di I grado ad indirizzo Musicale
Al Dirigente Scolastico
Oggetto: Richiesta di autorizzazione all’organizzazione di visite guidate – viaggi di istruzione (da presentare entro il 15/10/2018).  
___l__ sottoscritto/a_______________________________docente di____________________
CHIEDE
Alla S. V. l’autorizzazione all’organizzazione di 
•	Visita guidata (orario di lezione) 
•	Viaggio di istruzione (intera giornata)    
Motivo della visita: __________________________________________________________________________ 
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Meta del viaggio: __________________________________________________________________________ 
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Data/periodo del viaggio: __________________________________________________________________ 
Classi interessate: _______________________________________________________________________ 

Numero presunto degli studenti partecipanti: ___________, n° degli studenti diversamente abili_____(classe)_________________________________________________________

Programma di viaggio con specificato il tipo di trattamento richiesto:  

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Nominativi dei Docenti accompagnatori (eventuale nominativo del docente e/o assistente per gli alunni Diversamente abili): 
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Nome Cognome - Classe accompagnata   
_________________________________________________      classe________ 
_________________________________________________      classe________  
_________________________________________________      classe________  
_________________________________________________      classe________  
_________________________________________________      classe________  

Nome del docente organizzatore / referente di classe ___________________________________________
 
L’uscita è stata approvata dal Consiglio di Classe in data ___/___/______  

•	Autorizza 
•	Non autorizza                                                                                     
                                                                            IL DIRIGENTE SCOLASTICO
                                                                     Prof.ssa Aurelia Antonietta BAVUSO
                                                                                    Firma autografa sostituita a mezzo stampa ai sensi dell’art. 3 co. 2 D.Lgs. 39/1993 

 Lavello, ____/____/_______

                   
ISTITUTO COMPRENSIVO STATALE
“LAVELLO I”
Scuola dell’Infanzia, Primaria e Secondaria di I grado ad indirizzo Musicale

oggetto: RELAZIONE VIAGGI di istruzione/visita guidata   a 
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Nel periodo dal _____________al _________________ la classe _____________ accompagnata dai docenti _____________________________________________________________________, si è recata in visita guidata a_________________________________________________________ 

Alunni partecipanti n. ______ Alunni della classe non partecipanti n.______.

Comportamento degli allievi e considerazioni sul programma svolto
(a cura dei docenti accompagnatori)

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Osservazioni sull'organizzazione
(a cura dei docenti accompagnatori)
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Obiettivi didattici ed educativi raggiunti
(a cura del Coordinatore)

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I Docenti accompagnatori

________________________________________          ___________________________________  ________________________________________          ___________________________________
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                                                                                   ___________________________
                                                                                           Il Coordinatore di Classe
 Lavello, _______________