Video Conferencing Site Justification Form

If you would like to request a site or location be added to the DDN site listing, please complete and submit the form below. The form will automatically be emailed to Jay Etzkorn for review and approval.




District School Name:
* Required
School Address:
* Required
City:
* Required
State:
* Required
Zip:
* Required
Person Completing the Form:
* Required
Title:
* Required
Contact's Phone: Ex. 555-555-5555
* Required
Email Address:
* Required
Does this school have an existing DDN video unit:

* Required
If so, please list courses & events taken:
Site/Tech Coordinator Name:
* Required
Site/Tech Coordinator Phone: Ex. 555-555-5555
* Required
List those MS/HS classes you plan to take in the coming school year and number of students who will enroll. List only those classes which you strongly believe will be offered and you will enroll students:
Course Title & Other Events and Estimate Number of Students or Participants:

Please provide a brief summary for the need of a videoconferencing unit:


Enter Verification Code