Distance Learning Request Form

Fill out this request form to schedule classes.
Academic Class Information
Originating Campus:
Email Address:
Subject: (ex. PHST-P)
Catalog: (ex. 790)
Section: (ex. 21677)
Title:
Instructor:
Instructor Email:
Instructor Phone:
Participating sites
Room(s) or Polycom Unit Name(s):
Automate point to point connections? Yes No
Will this need to be archived with iStream? Yes No
Date / Time
Date:
Start time:
End Time:
Is this a recurring event? Yes No [If "No" then skip the recurrence pattern]
Recurrence Pattern
Recurring End Date:
Select one of the patterns: Recur on the following weekday(s)
Select the recurring weekdays: Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Please write down known omit dates (holidays, etc.):
Please write down other details regarding this request:

If you have a site from outside IU participanting, please provide:
Technical contact name, phone and email.
Site name and IP address.