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Multimedia Support

IVC Room Request Form

for Events, Meetings, & Workshops

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 *

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 		   


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