Administrative Circular 19

SAN DIEGO CITY SCHOOLS
COMPLIANCE FORM FOR SELLERS OF EDUCATIONAL TRAVEL

Information required by SB 142 is to be completed by travel organizations which offer educational travel programs to California students.

REQUIRED SECTIONS REFER TO THE BUSINESS AND PROFESSIONAL CODE

SCHOOL:_________________________________________________________________

DESTINATION:____________________________________ DATES:__________________

__________
Compliance

1 . Is the proposed student trip educational in nature? Yes/No_______
17552(c)

__________
Compliance

2. Company Name:__________________________________________________________

Address:___________________________________________________________________

Phone Number:______________________________________________________________

24-Hour Emergency Phone Number:_____________________________________________
17554(a)

__________
Compliance

3. List Services:
17554(b)
(Fill in or attach detailed application form)

Total cost per student for services listed below $__________________________________

Transportation:______________________________________________________________

Lodging:___________________________________________________________________

Meals (which meals are offered)________________________________________________

Educational leader ( Yes/ No ) Hours per day:____________________________________

Travel organization's office nearest tour site:______________________________________

__________
Compliance

4. Insurance Resume:
17554(b)1

Type ______________________	Coverage $ Per Incident ______________________	$ Total ______________________
Insurer ______________________	Policy # ______________________	Verify Name/Phone ______________________
Type ______________________	Coverage $ Per Incident ______________________	Coverage $ Total ______________________
Insurer ______________________	Policy # ______________________	Verify Name/Phone ______________________
Type ______________________	Coverage $ Per Incident ______________________	Coverage $ Total ______________________
Insurer ______________________	Policy # ______________________	Verify Name/Phone ______________________
Type ______________________	Coverage $ Per Incident ______________________	Coverage $ Total ______________________
Consumer Protection Deposit Plan
Insurer ______________________	Policy # ______________________	Verify Name/Phone ______________________

Optional extra cost insurance:_______________________________________________

Optional insurance cost per student $:________________________________________

__________
Compliance

5. Describe any additional or optional trip costs:________________________________
17554(b)2

__________
Compliance

6. Tour leader qualifications and training:______________________________________
17554(b)3

__________
Compliance

7. Describe educational components of travel program including projected outcomes: (Measurable objectives, hands-on activities, skill development, etc.)
17554(c)

________________________________________________________________________

Attach copy of relevant educational materials. (program specific curriculum correlation with state framework. classroorn supplements, etc.

__________
Compliance

8. How many times has the travel organization conducted this (or substantially similar) educational compliance programs?
17554(d)

Trip Name	Annual # of Groups	Annual # of Students	Annual # of Travel Days	Number of years offered
____________________	________	________	________	________
____________________	________	________	________	________
____________________	________	________	________	________
____________________	________	________	________	________
____________________	________	________	________	________
____________________	________	________	________	________
____________________	________	________	________	________

__________
Compliance

9. Length of time organization has conducted educational travel programs:____________
17554(e)

__________
Compliance

10. Name(s) of owner(s) and principals of student travel organization:

Name	Position
__________________________	___________________________
__________________________	___________________________
__________________________	___________________________
__________________________	___________________________
__________________________	___________________________

__________
Compliance

11. Has any owner or principal of the organization had entered against him or her any judgment, including stipulated judgment, order, lien, has entered a plea of nolo contendere, or been convicted of any criminal violation, in connection with the sale of any travel services from a period of 10 years predating the contract. 17555(g)

For purposes of this section owner"means a person or organization who owns or controls 10 percent or more of the quality of, or otherwise has claim to 10 percent or more of the net income of the educational travel organization: and "principal" means an owner, an owner, an officer of a corporation, a general partner of a partnership, or a sole proprietor of a proprietorship. 17554(g)

Name of defendant:________________________________________________________

Court or administrative agency rendering judgment order:_________________________

Docket Number:______________________ Date of judgment order:________________

Nature of judgment, order, or plea:

_________________________________________________________________________

12. How many full time employees does the organization have?____________________

13. How many office locations does the organization have?________________________

Where are the locations?____________________________________________________

14. Does the organization provide classroom support materials?____________________

Describe:________________________________________________________________

_________________________________________________________________________

15. Does the organization provide a format for post trip evalutation?:_________________

16. Are any of the principals of the organization credential and/or experienced teachers? Explain.

_________________________________________________________________________

17. Financial stability:
A. List bank(s), references, including persons name and phone number:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________

B. Dunn and Bradstreet file number:___________________________________________

C. Has the organization or any principal filed corporate or personal bankruptcy during the preceding 10 year? If yes, please explain on a separate sheet. Yes / No___________

18. List of 10 references (with phone numbers) of educators who have experienced the organization's services.

_____________________________   __________________________
_____________________________   __________________________
_____________________________   __________________________
_____________________________   __________________________
_____________________________   __________________________

19. Travel associations to which organization currently belongs:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________

20. Educational associations to which organization currently belongs:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________

21. Does travel organization currently hold an appointment from ARC? Yes / No_______

ARC/IATAN No.__________________

If no, which agency will provide travel agency?

Agency name:____________________________________________________________

Owner:_______________________________________ ARC/lATAN No._____________

Phone No.____________________________________

22. Has the travel organization complied with the consumer protection requirements of California's Seller of Travel law? Yes / No_____________________

23. FULL DISCLOSURE: 17555 In addition to other requirements and prohibitions of this article, it is a violation of this article for an educational travel organization to place or use any misleading or untruthful advertising or statement or make a substantial misrepresentation in conducting an educational travel program.

24. PENALTIES: 17556.5 Except as otherwise provided, a person who violates a provision of this article is guilty of a misdemeanor, which offense is punishable by a fine not exceeding one thousand dollars ($1,000), or by imprisonment in a county jail for not more than one year, or by both that fine and imprisonment. In addition, upon a conviction of a violation of this article, the court may issue an injunction and prohibit the convicted person form acting as an educational travel organization in this state, in which case the Court shall inform the Attorney General of that action.

Reference: California Business And Professions Code Chapter 1

VERIFICATION

A duly authorized officer of the owning corporation, partnership, or trust must sign and date this verification, and fill in the city and state where signed.

I declare that all of the information provided herein, including attachments to this Application to provide Travel Services, is true and correct.

Signature:___________________________________ Date:_______________________

Position:____________________________________ Signed at:___________________
City and State