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Information Technology Department

Video Conferencing Request Form

Video Conferencing Request Form

This form may be used to request a reservation for Harvard School of Public Health Video Conferencing facilities. Completing this form does not guarantee availability of video conferencing facilities. You will be sent confirmation of room availability to the email address you specify below.

Event Information 

Date of Video Conference:

Start Time:

End Time:

Meeting Name:

Originator:

Originator Email:

Originator Phone:

Department:

Contact Person:

Contact Person Phone:

Number of Attendees at HSPH:

Is this a class?
Yes No

Call originated from:
Near End Far End

Type if connection:
ISDN IP

First time user?
Yes No

Training needed?
Yes No

Billing Information 

33 Digit Billing Code:

Billing Contact:

Far End Information 

List the Far End site(s):

First time connection with Far End site?
Yes No

Far End Contact:

Phone:

Equipment:

Network:

Video Phone #1:

Video Phone #2:

Room Number:

Equipment Needed at Near End

Fax:
Yes No

Phone line for modem:
Yes No

Document Camera:
Yes No

Scan Converter:
Yes No

LAN Connection:
Yes No

Please add other details as needed: