Contact Information			Technology I will use (check all that apply):
First Name			Video Conferencing	Yes	No
Last Name			Course Management Software	Yes	No
College			TV/Video/Audio	Yes	No
Department			Streaming Video	Yes	No
Phone			DVD/CD-Audio	Yes	No
E-Mail			Satellite	Yes	No
OSU Extension Appointment? Yes No			Other, please specify

Sites and Equipment Please check what equipment you will need for each site.
Location	IP Video	Document Camera	Presentation PC	Internet drop	LCD projector	Student PCs
Kottman Hall
OSU Learning Center South
OSU Learning Center East
Godman Guild/OSU Extension Learning Center
OSU Extension Center Findlay
Wooster/OARDC

Course Specifics Please fill in these details about your course.
Is program for credit? Credit Non-Credit
Enter expected number of students at each site:
Kottman
South Center
East Center
Godman LC
Findlay Center
Wooster/OARDC

Enter program title, dates and times:

End of Form You have completed the Distance Education Resource Request. Click the "Submit" button to send register your request. You will be contacted within 2 business days.

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