Distance/HPLL Reservation Request Form Review the HPLL/Distance public calendar (Outlook Web Access) to check for connection availability. If the desired time and date are free, fill in the form below and save the edited document. Attach and email the finished form to your building principal. *Note: The rooms indicated below are already prepared to receive the HPLL connection/HPLL mobile cart. If you desire to use another room number, indicate other below and be sure to submit a help desk request 48 hours in advance in order to have another room activated for the HPLL cart!

Title of Session or Connection:

Cost for Connection: Date of Connection:

Start Time of Connection: End Time of Connection:

Connection Building Location: Connection Room Number: OHS LGI OMS IMC Number of participants: OIS Media Room OES Media Room Other* *submit a help desk issue at least 48 hours in advance of the connection – see above notes Select Preferred Connection Equipment: What is the main purpose of the connection? HPLL Mobile Cart Staff Development OHS ITV/Distance Classroom Community Ed Either Curriculum Content Area (Provide brief description)

Other (Provide brief description)

The following items will be provided with the HPLL Mobile cart checkout:  42” HD TV with remote  Polycom/Camera with remote  Polycom microphone  Network and power cables (extra long)

Requesting Staff Member Name:

Name of trained individual providing support:

Please note the following:  A session utilizing the HPLL mobile cart must be requested allowing at least 48 hours for the cart to travel between buildings (i.e. there can be no other reservations 48 hours before the requested session). If the request is not made with 48 hours advance checkout time, the only option available will be for the users to connect in the building where the cart is currently housed. It will be the requesting staff's responsibility to contact that building’s principal if 48 hours advance notice for the cart checkout can’t be given. The ITV room in the OHS does not require travel time for equipment, though there is limited availability due to scheduled distance class periods.  If a user will be connecting in the OHS ITV room the user must have attended the ITV room training at the beginning of a school year or must have a trained individual to assist with the initial connection.

Approved by (Principal’s Signature):

Date: Expenditure Code: