Videoconferencing Request Form

Students: If you wish to participate in a videoconference for an employment interview, please contact the Career Center at 617-552-3430.
Faculty and Staff: If you are looking for information concerning desktop videoconferencing, please contact your Technology Consultant (TC) to schedule an appointment. Your TC will need a couple weeks notice to meet with you in order to determine the best way to create a face-to-face conference.

Requester Name:		Department:
Telephone:		E-mail:
Tell us about the event and your needs:
Event Title:
Event Date:
Number of people attending:
Location
Starting Time:
Duration
Service Requested/Specific Needs (if known):
Will you be using any of the following audio/visual aids during your presentation?		PowerPoint presentation Videocassette Player DVD Player
Site details:
Do you need to connect to more than one site?		Yes No
If yes, how many?
Site One Contact Information		Site Two Contact Information
Name		Name
Phone Number:		Phone Number:
Email		Email
Organization		Organization
* Remote IP Address or ISDN # :		* Remote IP Address or ISDN # :
Site Three Contact Information		Site Four Contact Information
Name		Name
Phone Number:		Phone Number:
Email		Email
Organization		Organization
* Remote IP Address or ISDN # :		* Remote IP Address or ISDN # :

* If you do not know the IP address or ISDN number , please contact the remote site to get this information.

Campion Hall Rm G36, 140 Commonwealth Ave., Chestnut Hill, MA 02467
main tel 617.552.4500 main fax 617.552.2174