Forms Directories Search Contact Us

Multmedia Support
 IVC Classroom Request Form
for Credit and CE Classes


To reserve an IVC room, complete the form
below and submit it when you are finished.
Note: * = Required Fields

Date of Request*

Requester Name * Requester Phone *
Requester E-mail *
Person Using Room *

 User Phone *
 User E-mail *

Training Needed *
Yes No

 Review Needed *
Yes No

Class Title *

or
Description of Other Use
(i.e. test review, orientation, meeting)


Class Start Date *

or
Other Use Start Date

Class End Date *

or
Other Use End Date

Day(s) of Week Room is Needed (check all that apply)
Mo Tu We
Th Fr Sa

 Begin Time *
i.e. 08:15 (If session starts at 8:30, indicate start time 15 minutes early.)		 End Time *
i.e. 11:45 (If session ends at 11:30, let the connection last 15 minutes longer.)
Instructor Campus Location (Origination Site) *

Connecting to Location (Destination Site) *

 
     
Single Site (Check here if request does not require connection to another site):    
If originating site is not listed above, please specify:

 If receiving site is not listed above, please specify:
  
     

Facilitator Needed? *
Yes No

 

  

Multiple Date IVC Sessions
(Complete one line below for each multiple IVC use)

If you have any questions or need additional help, call Multimedia Support at 223-8083.

Use 1:
Date 1:
Day(s) 1:
Begin Time:
End Time:
Multiple Use 1:
Date 1:
Day(s) 1:

Begin:

 End:
Instructor Loc. 1: Connect To 1: Facilitator Needed:    
Instructor Location 1:
Connect to Loc. 1:
Facilitator Needed 1?
Yes
No 		   
         
Use 2:
Date 2: Day(s) 2: Begin Time: End Time:
Multiple Use 2: Date 2:
Day(s) 2:

Begin:

 End:
Instructor Loc 2: Connect To 2: Facilitator Needed:    
Instructor Location 2:
Connect to Loc. 2:
Facilitator Needed 2?
Yes
No 		   
         
Use 3:
Date 3: Day(s) 3: Begin Time: End Time:
Multiple Use 3:
Date 3:
Day(s) 3:

Begin:

 End:
Instructor Loc 3: Connect To 3: Facilitator Needed:    
Instructor Location 3: Connect to Loc. 3:
Facilitator Needed 3?
Yes
No 		   
         
Use 4:
Date 4: Day(s) 4: Begin Time: End Time:
Multiple Use 4:
Date 4:
Day(s) 4:

Begin:

 End:
Instructor Loc. 4 Connect To 4: Facilitator Needed:    
Instructor Location 4:
Connect to Loc. 4:
Facilitator Needed 4?
Yes
No 		   


Feedback:

or