Northeast Texas Network
Video Conference Request Form

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Please complete this form, making sure to fill in the required fields (marked with red asterisks *). If you do not fill in all the required fields, you will not be able to submit the form.
Check the availability of your desired event time using the VCWizard tool. Log in with username: guest, password: netnet. Access a VCWizard tutorial here.
Requests must be made at least 24 hours in advance. If your desired event time is within the next 24 hours, please call (903) 877-7510 to ensure the event can be scheduled.
It is recommended that you keep a copy of the form for your records. To receive a copy via email, enter your email address in the CC Address box at the bottom of the page. To print a hard copy of the form, click the Print Summary button on the Confirmation page after submitting the form.
Click on the Submit Form button. A message will appear noting that your request has been received.
Click the Start Over button on the Confirmation Page to request another event

This section contains your site information

My Institution: *		Department: *

Event Dates: *	Event Times: *	Day(s) that Class Meets: *
From: To:	From:AMPM To:AMPM Have the times above been adjusted to include setup/buffer time? YesNo	Monday Friday Tuesday Saturday Wednesday Sunday Thursday
Event Bldg/Room#: *	Room Type: *	Room Phone: *
	MPEG (NETnet) Other
Credit(s) Available: *	Accrediting Organization: *

Event Title/Class Name and Number: *

Event Description (150 words or less): *

Event Coordinator: *	Technical Coordinator: *
Name: Phone: Cell/Pager: Email:	Name: Phone: Cell/Pager: Email:

This section contains remote site information

Site #1 Information:: *	Site #1 Technical Coordinator: *
Site Name: Bldg Name & Room Number: Room Phone: Room Type: MPEG (NETnet) Other	Name: Phone: Cell/Pager: Email:

Check this box to enable Site #2

Site #2 Information:	Site #2 Technical Coordinator:
Site Name: Bldg Name & Room Number: Room Phone: Room Type: MPEG (NETnet) Other	Name: Phone: Cell/Pager: Email:

Check this box to enable Site #3

Site #3 Information:	Site #3 Technical Coordinator:
Site Name: Bldg Name & Room Number: Room Phone: Room Type: MPEG (NETnet) Other	Name: Phone: Cell/Pager: Email:

Check this box to enable Site #4

Site #4 Information:	Site #4 Technical Coordinator:
Site Name: Bldg Name & Room Number: Room Phone: Room Type: MPEG (NETnet) Other	Name: Phone: Cell/Pager: Email:

Check this box to enable Site #5

Site #5 Information:	Site #5 Technical Coordinator:
Site Name: Bldg Name & Room Number: Room Phone: Room Type: MPEG (NETnet) Other	Name: Phone: Cell/Pager: Email:

Check this box to enable Site #6

Site #6 Information:	Site #6 Technical Coordinator:
Site Name: Bldg Name & Room Number: Room Phone: Room Type: MPEG (NETnet) Other	Name: Phone: Cell/Pager: Email:

Check this box to enable Site #7

Site #7 Information:	Site #7 Technical Coordinator:
Site Name: Bldg Name & Room Number: Room Phone: Room Type: MPEG (NETnet) Other	Name: Phone: Cell/Pager: Email:

Check this box to enable Site #8

Site #8 Information:	Site #8 Technical Coordinator:
Site Name: Bldg Name & Room Number: Room Phone: Room Type: MPEG (NETnet) Other	Name: Phone: Cell/Pager: Email:

Check this box to enable Site #9

Site #9 Information:	Site #9 Technical Coordinator:
Site Name: Bldg Name & Room Number: Room Phone: Room Type: MPEG (NETnet) Other	Name: Phone: Cell/Pager: Email:

Check this box to enable Site #10

Site #10 Information:	Site #10 Technical Coordinator:
Site Name: Bldg Name & Room Number: Room Phone: Room Type: MPEG (NETnet) Other	Name: Phone: Cell/Pager: Email:

Recipient Information

If you would like to receive a carbon copy of your completed form, please enter your email address below.

CC Email Address: