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Request Service

Video Conference Request Form

This form serves the following purposes

• Two-way video with other CSU/UC campuses
• Administrative meetings with other CSU campuses, Chancellors office, and state agencies
• Video Over IP (H.323) capability (connect with other parties around the world using H.323 technology)
• We have 2 studios equipped with video conference technology
• For distance learning videoconferencing, fill out a General Production Request

Students: Please do not use this form. Instead, request assistance by emailing mediavision@csupomona.edu or by calling 909 979 6324

Conferencing Information

First Name
Last Name
Faculty/Staff	Faculty    Staff
E-mail
Telephone
Department
Project Title
Project Date
Begin time (PST)	a.m. p.m.
End time (PST)	a.m. p.m.
For what course code (e.g. 33146) will the material be used?
Purpose of Project (state in terms of effect on student learning)
List the names of the other connected sites/campuses
Who will attend the conference at Cal Poly?

Contact Info of other sites (if other site is a CSU, contact info may not be required)

site
contact name
contact email
contact number

If this is for a course, please supply the following:

Quarter

Course (e.g. 33146)

Comments/ Additional Info

Please type in any additional comments and information below

NOTE: You will receive an email within five working days informing you of the status of your request.