CIC Video Conferencing Request Form

The CIC Chief Information Officers have contracted with the Internet2 Commons to provide multipoint video conferencing services for CIC groups interested in using IP (Internet Protocol) video conferencing.

The multipoint service allows for more than two sites to participate in the same video conference. There is no charge to you for this service, however, each participant site must use its own video conferencing equipment and pay any related fees on their campus. To locate available video conferencing facilities and support on your campus, contact your CIC Video Conferencing Support Representative.

Instructions
Fill out and submit the CIC Multipoint Video Conferencing Request Form 10 days in advance of the multipoint video conference. You will receive a confirmation email that contains dialing instructions for you to send to your videoconferencing participants.

Your Contact Information
Name:
Organization:	Select One CIC Office Indiana University Michigan State University Ohio State University Northwestern University Pennsylvania State University Purdue University University of Chicago University of Illinois at Chicago University of Illinois at Urbana-Champaign University of Iowa University of Michigan University of Minnesota University of Wisconsin-Madison
Email:
Phone:	(Please use format 217-555-1234)
CIC Group:	Select One Academic Leadership Program Liaisons Accreditation Network AESOP Coordinators Affirmative Action Panel CIC Members (Chief Academic Officers) Chief Information Officers (CIOs) CIO Licensing Task Force CIO TechForum Planning Committee CLI Chairs CDO/ERO Committee on Engagement Department Executive Officers (DEO) Liaisons Digital Library Initiatives Overview Committee Faculty Governance Leaders Foreign Language Liaisons Board Graduate Deans Heads of Government Publications Heads of Reference Health Science Library Directors Interlibrary Loan Directors Int'l Student and Scholar Services Directors IT Communications Group IT Customer Support Services Group IT Financial Group IT Human Resources Group IT Operations and Infrastructure Group IT Security Working Group Learning Technology Group Liberal Arts and Sciences Deans Library Directors Library Information Technology Directors Minority Access Panel Preservation Officers Public Service Directors Purchasing Directors Senior Diversity Officers Senior International Officers Senior Research Officers Study Abroad Officers Technical Services Directors Telecommunications Group Undergraduate Education Group University Archivists Group University Press Directors Video Working Group Women in Science and Engineering (WISE) Panel Women's Advocacy Network Other Group
Video Conference Scheduling Information
Date:	/ / (mm/dd/yy)
(We will open the VC 15 minutes before your start time to allow participants to connect, and will close exactly at your end time. If you discover you need more time during the conference, call Internet2 at (614) 292-8443 and request more time.)
Start Time:	:   a.m.    p.m.  (Eastern Time)
End Time:	:   a.m.    p.m.  (Eastern Time)
Total Number of Participating Sites:
	Please indicate CIC sites:
CIC Office:		Michigan State University:
University of Chicago:		University of Minnesota:
University of Illinois at Chicago:		Northwestern University:
University of Illinois at Urbana-Champaign:		Ohio State University:
Indiana University :		Pennsylvania State University:
University of Iowa:		Purdue University:
University of Michigan:		University of Wisconsin-Madison:
Please list non-CIC sites, or additional sites at CIC Univ. (if any):
Bitrate: (This is the speed of your connection - everyone must be at the same speed, usually 384 kbps.)	128 kbps (Home) 384 kbps (Campus Network) 512 kbps (Campus Network) 768 kbps (Campus Network)
(Select a screen configuration from the choices here, or include a special request below if you have another preference.)	If yes, which format? Voice-Activated (See Who's Talking) Side by Side Two by Two One by Three One by Five One by Seven Three by Three   + Lecture Mode: Audience sees only presenter, presenter sees whichever option selected above
Streaming Required: (This will provide a web address for you to give to anyone you would like to view the videoconference live. Such a viewer would not be able to participate in the conference.)	Yes    No
Archiving Required: (This will provide a web address to view the videoconference later for up to 3 weeks.)	Yes    No
Comments or Special Requests: