ITV Classroom Request Form

Please return one full semester prior to the start date of your course.

Fax: 201-692-7273, Attention: Subhojit Paul
Mail Code: H-DH2-15, Attention: Subhojit Paul

First Name

Last Name

Department

Mail Stop

Email

Work Phone

Class Title

Requested Class Date

Requested Class Time

Class Audience (e.g. FDU Full Time students, corporate partners etc.)

Date the Instructor completed or expects to complete the Training

Type of connection requested	Metropolitan - College at Florham only Metropolitan - College at Florham - External Sites Metropolitan - External Sites College at Florham - External Sites

If you need to connect to external sites, please provide the names of the sites plus the name & phone number of a contact person at each external site, and a budget code.

Budget Number for Chargeback

Site 1

Name of Site

Name of Contact Person

Phone Number of Contact Person

Site 2

Name of Site

Name of Contact Person

Phone Number of Contact Person

Site 3

Name of Site

Name of Contact Person

Phone Number of Contact Person


Comments



Thank you for the request. Please do not schedule your ITV classes/meetings until you receive a confirmation from the Center for Teaching and Learning with Technology. No instructor may be scheduled to teach in the ITV room unless he or she attends training on using the sophisticated ITV equipment. Training should be scheduled as soon as possible after the instructor is identified, preferably a month prior to the start date of the course. To arrange for training, please call 201-692-7060. Please check this box if the instructor for this class has been trained by the CTLT office to properly use the ITV equipment.

I have read, and agree to abide by the ITV Policies and the CTLT Policies.

I understand that I may not designate an ITV course location in the course booklet until I have received confirmation from the Center for Teaching and Learning with Technology.