Video Conferencing Participant
Connectivity Form

This form must be submitted at least once a school year.  All fields marked with an * are required.  You should participate in a connectivity test prior to your first scheduled conference.  You can request a test below.

* Name of Institution/Individual:

* Name of Program Contact:

* Phone # of Program contact:

* E-Mail for Program Contact:

Technical Contact (Distance Learning Contact):

Phone # for Technical Contact:

E-Mail for Technical Contact

Name of Bridge Contact, if any:

Phone # of Bridge contact:

E-Mail for Bridge Contact:

* Make/Model of Video Conferencing Equipment being used:

* Software version:

* Connection Method:

* IP or ISDN number (please include area code if ISDN):

* Connection Speed:

* Will you be dialing in to our bridge, or us out to you? (ISDN sites must dial in to Vanderbilt's Bridge.)

Are you registered with a Gatekeeper?

If yes, what is the IP number of the Gatekeeper?

Please request a connectivity test if you have not been tested on Vanderbilt's bridge within the last year.  Testing sessions are usually less than 30 minutes in length.  Program contacts will be notified via e-mail to schedule a test time.

Questions may be directed to collaboration@vanderbilt.edu or via phone at (615) 343-9999, option 5.

*Connectivity Test Status: