Poland Central School District Request for Services through Herkimer BOCES: Arts in Education and Enrichment
NOTE: School districts make reservations and arrangements; BOCES makes contracts and payments.

This process often takes 6-8 weeks so you must fill out this form well ahead of the program date. Curriculum supporting material is required before the request is approved.

Deadline for requests is the last day of school in April of that school year. PLEASE PLAN AHEAD!!!

IMPORTANT: Consultants are allowed to have contact with students only when a district employee is present. Your submission of this form indicates that your school personnel understand this, and that consultants in your school will not be asked to violate this rule.

Cancellations: It is the district’s responsibility to notify the Office of Enrichment (enrichment@herkimer-boces.org or 315-867-2077) immediately, if for some reason the event is cancelled or does not occur as scheduled. We will process payment unless we hear otherwise from you. Your submission of this form indicates your awareness, on behalf of your district, of our cancellation policy.

Email address *
Participating Teacher/s Name
Grade Level/s participating *
(Pre-K alone is not eligible for aid through the Arts-in-Ed/Enrichment CoSer and will therefore be denied. Please consider inviting Kindergarten/other grade levels to participate in the event in order to receive aid.)
Subject/s to be covered
Vendor Name (Used for payment) *
Vendor Contact
Vendor Address
Vendor Phone
Vendor Email
Start date and time *
End date and time *
Does vendor accept PO's? *
Deposit/Payment due date
Due date not required - Payment will be paid within 30 days after event unless noted here
Total # of student tickets
Cost per student ticket
Total # of adult tickets
Cost per adult ticket
Total # of complimentary tickets
Total amount due to vendor *
Please note any other relevant payment information here (i.e. invoice number, order number, account number, multiple payment deadlines, etc.)
Upload invoice, reservation confirmation, registration form, or any other payment information here
Payment: BOCES is in charge of payment -- do not pay consultant directly.
What arts/curriculum connection will your students experience while attending this event? *
How does this program/visit connect to the Arts Learning Standards? *
How does this program/visit connect to the other learning standards? *
How will you prepare your students for this program/visit?
How will you follow up this program/visit with your students?
*** New York State Education Department requires schools to show that Arts-in-Education and Enrichment Activities are integrated into the curriculum in order to be BOCES-Aidable. You must include appropriate standards that relate to your activity in order to be approved for Aid.
Check all standards that relate to your activity below.
Does your activity correlate with a New York State Learning Module? *
If the answer is yes, please list the module in other.
Please check which Arts standards apply:
Anchor Standards for the Arts
Please check which ELA standards apply:
Anchor Standards for ELA: Speaking and Listening
Please check which Social Studies standards apply:
Anchor Standards for Social Studies
Please check which Science standards apply::
Next Generation Science Standards: Scientific and Engineering Practices
Please check which Math standards apply:
Anchor Standards for Math
Other Standards
List other standards and appropriate curricular connections if any.
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