BACK TO ACADEMICS SSCSD Videoconference Request Form
All Fields are required please choose or type NA in fields that are not applicable!
Instructional Technologists are required to follow-up on your videoconference submission before forwarding the requests
to the Director of Information Technology. Please note: videoconferences are subject to approval by the Director of Information Technology.
Level(s): Click Arrow to Choose Level Elementary Middle School High School Interschool: Elementary-Elementary Interschool: Elementary-HS Interschool: Elementary-Middle Interschool: Middle-HS Contact Teacher: Course/Subject:
Grade Level: Room #: Building: Click Arrow to Choose Building Caroline Street Division Street Dorothy Nolan Geyser Road Greenfield High School Lake Avenue Maple Avenue Administration Building Location of Videoconference: Click Arrow for Location My Classroom Library/Media Center Large Group Activity Room Distance Learning Room Auditorium Conference Room Cafeteria
Best way to contact you: Click Arrow Email Leave a Message in Office Phone/Cell Phone Phone number you'd like us to use:
Please indicate the number of students to attend videoconference:
Name of Content Provider/Contact Name: Type of Connection: Click Arrow IP ISDN Not Sure
Name of videoconference program: Cost (no $ or decimal required):
Instructional Purpose:
Date for which you'd like to schedule this videoconference (please use 00/00/00 format):
If NO alternate date(s) please type 00/00/00 in the field
Alternate Date 1 (please use 00/00/00 format):
Alternate Date 2 (please use 00/00/00 format):
Alternate Date 3 (please use 00/00/00 format):
Please indicate the block and times (HS), period and times (Maple) or times (Elementary) you would like your videoconference to be held Please type na in fields you do not need.
High School:
Maple Avenue:
Elementary:
Block: Click Arrow for Block NA Block 1 Block 2 - Regular Block 2-Split Block 3-Early Block 3-Split Block 3-Late Block 4
Period: Click Arrow For Period NA Period 1 Period 2 Period 3 Period 4 Period 5 Period 6 Period 7 Period 8 Period 9
Start Time:
Additional Comments/Instructions:
Thank you for your submission. You will get confirmation from your instructional technologist once you have gotten approval and your videoconference has been scheduled.
DON'T FORGET TO CLICK ON SUBMIT (BELOW). WHEN YOUR CONFIRMATION PAGE APPEARS PLEASE PRINT IT!
BACK TO ACADEMICS