Contact Information

*Requested by:

Affiliated with UNMC TNMC Both or Neither**

**If neither, please include mailing address:

*Unit/College: Select one TNMC The Nebraska Medical Center UNMC Academic Affairs UNMC Allied Health UNMC Business & Finance UNMC Chancellor's Office UNMC College of Dentistry UNMC College of Medicine UNMC College of Nursing UNMC College of Pharmacy UNMC College of Public Health UNMC Eppley Institute UNMC Human Resources UNMC Information Technology Services (ITS) UNMC Munroe Meyer Institute UNMC Research UNMC Students UNMC University Physicians UNMC Off Campus Event NSTN (Nebraska State Telehealth Network) OTHER

If other....

*Requestor Phone:

*Requestor Email: 

Event Information

*Event Title:

*Start Date: 
*End Date:

*Start Time (actual):  AM PM CT
*End Time (actual): AM PM CT

Video Services starts sets up, including connection, 30 minutes prior to start time.

Event Description/additional scheduling information (excluded dates, special dates, etc.)
Useful Information

if Recurring... Weekly, select day(s) of the week
M   Tu   W  Th  F  Sa  Su 

List Custom Dates/Times (i.e. 3rd FRI of each month):

UNMC/TNMC Location

Video Services will assist in scheduling the appropriate location if needed. If scheduling your own room, please schedule the room 15-30 minutes prior to actual start time.

*Please select: I have reserved a room or I need a room

Number of anticipated campus attendees:

Requested Services

Descriptions of Technologies for Videoconferencing

Video conferencing to other site(s)

Live One-way Streaming to Web Viewers

Archiving to UNMC Server (Archives are created in Real Media and pushed to a folder on the UNMC Server)

URL (if known):

DVD Recording
There will be charges for DVD recordings. Please provide payment information

Cost Center Number/alternative Payment information:
DVD will be picked up DVD will be mailed (provide address with zip code, if different from contact information)

Computer Information

Presenting a Power Point Presentation Select one With Embedded Audio With Embedded Video With Embedded Audio & Video

Bringing your own Laptop (If Mac, bring your adapter)

Video Conference Details

Joining a Video Conference

List Originating Site/Contact:

Hosting a Video Conference (designate type)

List distance sites (if known):

Telehealth Consult (distance sites must have encrytption capabilities)

Meeting

Lecture

Additional Program Information - Outside Nebraska technical support email/phone; Presenter(s) information; specific meeting details, etc.