Videoconferencing Services
 
S  E  R  V  I  C  E     R  E  Q  U  E  S  T     F  O  R  M
 

* Denotes a Required Field

  
     
 

Scheduling Information

  
 
 Scheduler's Information  
Requested by: *    Department: *   
Job Title :        Email Address: *   
Phone Number: *         

 

      
 
     
 
  Event Information
Event Name:   
Origination Location:   
Event Coordinator:    

Email Address:

   
Phone Number:         
   
  
     
 
  Conference Time
Conference Date: *                
Pre-Test Time: *      :      am       pm          Time Zone: *  
Conference Start Time: *      :      am       pm
Conference End Time: *      :      am       pm
        
  
     
   Conferencing Details  
     
 
 UH Facilities Information    
Videoconferencing Room Needed:*   Yes       No                 
Room Seating Capacity:*  

Type of Conference:*

   Point to Point      Multipoint Conference     (More than 2 sites)  

If Multipoint, Number of Sites:   

 

Do you need a Multipoint Bridge:  

  Yes       No 

Transmission Rate:   

 
     
 
     
 
  Remote Conferencing Room Profiles
Site 1

Company Name: *

    

City, State : *

  

Country (if other than U.S.):   

 

IP or ISDN Number: *

  

Originates Call:   

  Yes       No 

Technical Contact: *

  

Contact Phone: *

  

 

 MCU Profile:     (Multipoint Conferencing Unit Required for additional sites)
MCU Service Provider:      IP or ISDN Number:  
MCU Technical Contact:      Contact Phone Number:     
 
 

Site 2
Company Name:        
City, State :        Country (if other than U.S.):     
ISDN Full Number:      Originates Call:      Yes       No 
Technical Contact:        Contact Phone:     
       

Site 3
Company Name:        
City, State :        Country (if other than U.S.):     
ISDN Full Number:      Originates Call:      Yes       No 
Technical Contact:        Contact Phone:     
       

Site 4
Company Name:        
City, State :        Country (if other than U.S.):     
ISDN Full Number:      Originates Call:      Yes       No 
Technical Contact:        Contact Phone:     
       

Site 5
Company Name:        
City, State :        Country (if other than U.S.):     
ISDN Full Number:      Originates Call:      Yes       No 
Technical Contact:        Contact Phone:     
       
 
     
 
  Additional Information
Special Requirements: *   
        
  
     
     
 

         

 

  
     
 

 

  
 

Updated November 23, 2004