Distance Learning - Videoconference Event Request Form

Instructional Support Center > Departments > Videoconference Event Reque...

11.20.09

Items denoted with a red asterisk * are required.

Technology Services will assist you in scheduling your next videoconference. In order to better serve your videoconference needs, please complete the form below.

Remember!
Submit the form three days before the event.

Turn the unit on prior to the designated connection time.

Mute all room Mic's until called upon or asking a question to the presenter or one of the other participating sites.

Be on time for your conference.

If you have any questions about the form or about the status of your conference contact Angela Conrad, 281.641.8365, or email: angela.conrad@humble.k12.tx.us

Requester Information

* Campus:

* Contact Name:

* Contact Phone:

- -

* Contact Email:

Program Information

* Program Title:

* Host Site

Who are we connecting TO? Who is providing the programming?

* Date of Connection:

For multiple connections, fill out multiple forms.

* Start Time:

(hh:mm am/pm)

* End Time:

(hh:mm am/pm)

* Is this a recurring connection?

Yes No

If yes, please describe the frequency of the connection.

Approx. how many students will attend the program?

Approx. how many adults will attend the program?

Connection Information

Will you need assistance setting up the Polycom equipment?

Yes No

* Have you reserved a room for this connection?

Yes No Not necessary

If yes, building and room number:

IP address for this connection:

This is the IP address for the far site that you are connecting with.

Additional Contact Information:

* Is this a TETN connection:

Yes No

If yes, TETN Event Number:

Do you need this session streamed and/or recorded?

Yes No

If yes, please leave details in the box below.

Other Information: