new request form

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.
Requests must be made at least 24 hours in advance. If your desired event time is within the next 24 hours, please call (903) 877-1200 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 that will notify you that your request has been received.
Click the Start Over button on the Confirmation Page to request another event
Buffer time Change!! Please insert the exact time you want the class to start. Remember if you are doing back to back classes, place ONE minute in between the end time of one class and the start time of your next class.
New Option: IPVCR Recording ability: This option is still limited to certain facilites that we have setup on our equipment. Please call if you have any questions about this recording option.

This section contains your site information

My Institution: *		Department: *

Event Dates: *	Event Times: *	Day(s) that Class Meets: *
Start Date : End Date :	Start Time : AMPM End Time: AMPM Note: Put the EXACT time you want your class to start. Please build in your own buffer times.	Monday Tuesday Wednesday Thursday Friday
Event Bldg/Room#: *	Would you like this conference recorded?
	Yes No
Event Title/Class Name, Number and Teacher / Facilitator name: *
Example: PJC Engl 1301 Smith
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:

Northeast Texas Network
Video Conference Request Form