Videoconferencing Request Form

*Please allow 48 hours advance notice for processing*


STEPHEN F. AUSTIN STATE UNIVERSITY

Center for Teaching and Learning

P.O. Box 13038, SFA Station Nacogdoches, Texas 75962 (936) 468-2774


First Name: Last Name:

Area Code: Phone Number: Email Address:

Event Title:

Requested SFA Room Number:

Date of Conference - Month: Day: Year:

Day of Week: Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Start Time - Hour: Minute:

End Time - Hour: Minute:

Number of Conference Participants:

Presenter will be at SFA Presenter will be elsewhere N/A


Please list any special room needs below. (Such as a document camera or computer)



If the videoconference is to be scheduled more than once, please list additional times and dates below:


Please list a location name and a technical contact at other site(s). We must have this information in order to test connectivity between SFA and the other connection location(s).

Receive Site #1:

Site or Institution Receiving Videoconference From SFA:

Building and/or Room Number:

Site's Videoconference Coordinator and/or Technician's Name:
First: Last:

Phone: Email:


If SFA will be connecting with more than one site, please provide contact information for each additional location in the space(s) below:


Receive Site #2:

Institution Receiving Videoconference From SFA:

Building and/or Room Number:

Site's Videoconference Coordinator and/or Technician's Name:
First: Last:

Phone: Email:


Receive Site #3:

Institution Receiving Videoconference From SFA:

Building and/or Room Number:

Site's Videoconference Coordinator and/or Technician's Name:
First: Last:

Phone: Email:


Receive Site #4:

Institution Receiving Videoconference From SFA:

Building and/or Room Number:

Site's Videoconference Coordinator and/or Technician's Name:

First: Last:

Phone: Email:


Receive Site #5:

Institution Receiving Videoconference From SFA:

Building and/or Room Number:

Site's Videoconference Coordinator and/or Technician's Name:
First: Last:

Phone: Email:


For more than 5 additional receive sites, please list location and technician contact information for each in the space provided:


If you have questions or need additional information about videoconferencing at SFA, please email us: itv@sfasu.edu

Please check that all above information is complete and correct. We cannot process requests with incomplete information.