Video Conference Event Request

*Required Fields

Contact Information

*Requested by:

Affiliated with UNMC TNMC Both or Neither**

**If neither, please include mailing address:


If other....

*Requestor Phone:

*Requestor Email: 

Event Information

*Event Title:

*Start Date:  Calendar
End Date: Calendar

*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.)

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

VIDYO Room only

Total number of participants for VIDYO conference (max 25):

Scroll to the bottom of the form and Submit.

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

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)



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

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into the space below.

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Form last updated 01/28/14