Distance Education & Extended Studies

ITV Meeting Request Form

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 room request:

Name

Work Phone

FAX

E-mail

Meeting/Activity
(Example: Gen Ed Meeting )
Day requested:

Date:

Time : Start time (hh:mm)--

            End time (hh:mm)--

Origination Site Requested.

Receiving Site Requested :
Other Origination or Receiving Site

Is this a bridged call?     Yes No

If yes, please indicate other sites:
Please provide any other information that you believe necessary.