NEW
LINKS TO NEW LEARNING
RESERVATION FORM FOR VIDEOCONFERENCES
Please print
this form, fill it out and FAX it to Rebecca Polityka at 314-872-9128.
Name of videoconference program you are requesting:
_______________________________________________________________________
Date of program: _______________ Time of program: _______________
Alternate date: _________________ Alternate time: ________________
Teacher's Name: _________________________________________________________
School Name: ____________________________________________________________
Teacher's Phone #: ______________ Teacher's Email: ____________________________
Technical Contact at School: ____________________________ Phone: _______________
Phone in videoconference room: ___________________ Grade level of students: ________
Subject (if above elementary):_____________ #of classes participating: ____ # of students: ____
IP address of codec (videoconferencing unit)_________________________ OR
ISDN # of codec________________________________________
What is the educational goal of your participation in the program? (lesson
objectives)
What specific points/issues/facts do you want covered in this presentation?
What would you like your students to see visually in the presentation?
What supporting material would you like, if any?
Will this presentation be used to introduce, continue, or conclude your study of this topic?
Click here for a downloadable pdf file of this reservation form