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NC STATE
DELTA

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DE Classroom Request

Distance Education Classroom Reservation Form

Distance Education Classroom Use

Fill out the fields below. We will call you if we have questions, and will confirm your booking by email.

Please refer questions to Bob Klein NCSU/NC-REN Program Coordinator at 919-515-3683 or .

Course Number and Course Title*
Semester and Year*
Number of students expected at NC State*

Note: Number may be limited to seating in facility.

Course Administration*
Course Type*

Note: Credit courses have priority over non-credit courses.

Recorded Sessions*

Do you want these sessions to be recorded?

If yes, which format do you prefer?

If choosing more than one format, please explain below in "Comments/Special Needs" box.

Preferred Location*
Schedule - First Choice*

Meeting Days

Schedule - Second Choice*

Meeting Days

Schedule - Third Choice*

Meeting Days

Primary Contact at NC State*

(e.g. Administrator, Department Head)

Course Instructor*
Submitted By (if different from above)
Does this require a connection to another site?
Is NC State the originating site?*
NCREN Receiving Sites Help

Name(s) of NCREN Site and the Number of Participants

Add NCREN Site

NCIH Receiving Sites Help

You are responsible for contacting each NCIH site coordinator and confirming availability before booking with VCS. Please refer to the NCIH listing to get contact information.

** Disclaimer: There may be charges associated with the use of NCIH facilities

Name(s) of NCIH Site/Number of Participants*

Have you contacted the NCIH site coordinator?*

Add NCIH Site

Non-NCREN/Non-NCIH Receiving sites. Help

You are responsible for contacting each Non-NCREN/Non-NCIH site coordinator and confirming availability before booking with VCS.

Have you contacted the technical staff at the remote site to confirm availability? *

Technical Contact at Remote Site *

Faculty or Administrative Contact at Remote Site

Add Site

If NC State is not the originating site*

Technical Contact at Originating Site*

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