Questions in red are mandatory.
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1. Please complete the contact information below.
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First Name: |
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Last Name: |
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Company: |
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Address: |
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Address 2: |
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City/Town: |
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State: |
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Zip/Postal Code: |
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Country: |
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Email Address: |
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Phone Number: |
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Website Address: |
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2. Name of VC Program:
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3. List any awards your program has received.
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4. Procedure for requesting the program |
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Register on website
Contact via email
Contact via phone
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5. How far in advance should teachers register for the program? |
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6. Maximum number of participants/VC |
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7. Select subject from the Content Area drop-down menu. If subject is not listed
please use text box entitled Other Subject.
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8. Program Description (Please keep answers under 700 characters)
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characters left. |
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9. Can the length of the program be customized? |
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10. Program length |
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11. The program is available during the following months: |
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12. The program is available on the following days of the week: |
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13. The program is available between what hours, Eastern time zone? |
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14. Connection type available:
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IP
ISDN
Internet 2
SKYPE
WEBX
Other
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15. Bridge available? |
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16. Bridge cost: |
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17.
Program fee: |
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18. Cancellation policy (Please keep answers under 1000 characters)
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characters left. |
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19. Minimum Technology Specifications for sites connecting to this provider (Please
keep answers under 700 characters)
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characters left. |
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20. Test Connection Procedures (Please keep answers under 700
characters) You have
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