Video Network Information Center Request Form

Video Network Information Center Request

Please fill out the request form for the video conference you have in mind. When the form is summitted, Larry Cannon or Jerry Cole will contact you for additional information and schedule the conference for you.

Items with an * indicate a required field.

CONFERENCE
Conference Name *
Conference Date *
Start Time *
End Time *
Duration
Events	Multiple Single
Additional Dates
Number of students
Include students participating in all locations

CONFERENCE REQUESTED BY
Please select one of the following if you are a Charter School:	Charter School PVX Charter School FX
Name *
BSU Department

Office Number *
Mobile Number
Email *
Budget Code
The budget code is used for tracking purposes only.

FAR-SITE CONTACT PERSON
Please select one of the following if you are a Charter School	Charter School PVX Charter School FX
Name *
Office Number
Mobile Number *
E-mail Address *

FAR-SITE TECHNICAL PERSON
Name *
Office Number *
Mobile Number *
E-mail Address *
Comments