Video Conference Request Form
Please fill out this form in order to alert the Distance Learning Office that you have scheduled a video conference.
* Required
Today's Date
*
Teacher's Name
*
School
*
Teacher's Email
*
Teacher's Phone
*
Name of Vendor
*
Vendor's Phone Number
*
IP Address of Vendor
*
Contact Name at Vendor
*
Title of Video Conference
*
Standards that will be met (by number)
*
Confirmed Date of Video Conference
*
Confirmed Time of Video Conference
*
Have you scheduled a test call?
*
Yes
No
Date of Test Call
Time of Test Call
Will you need assistance from the Distance Learning Office?
*
No
Yes