New Media Video Conference Request Form

JTS Department Contact Information
Request Date:
Requesting Department:
Budget Code:
Name of Requester:
Requester's Email:
Requester's Phone:
Requested on Behalf of:
Event Information
Event Date:
Event Name:
Room Confirmation #:
**Please fill out a Room Request Form with Facilities if requesting a specific space.**
Number of Attendees:
Number of Locations:
Event Start Time: (Eastern Time)
Event End Time: (Eastern Time)
Video Test Date:
Video Test Time:
Please provide contact information and IP addresses for all conference locations:
Please provide any special details regarding this request for video conferencing: