Distance Education & Extended Studies

ITV Incident Report Form

If a technical problem with your ITV class or meeting has occurred, please complete the form below and submit to the Office of Extended Programs via the submit button.
If you have any questions contact Lynne Fleisher at Ext 2778 or e-mail ( lfleisher@clarion.edu).

Person submitting the incident report:

Name

Work Phone

E-mail

Class/Meeting/Activity
(Example: Nursing 645 )
Date of event :

(Example: 3/17/01)

Time of event:

Origination Site of call:

Receiving Site of call :
Other Origination or Receiving Sites:

Was this a bridged call?     Yes No

If yes, please indicate other sites:
Please provide as much additional information about the nature of the technical problem as possible.

We will endeavor to identify the problem and will notify you about the remedies undertaken as soon as possible.

Thank you for your assistance

Arthur J. Acton, Ph.D.

Assistant Vice President for Academic Affairs,

Extended Programs