Online Registration Form for Virtual Visits

Please note that the ETTC cannot guarantee the availability of a particular instructor. ETTC will work to schedule these events at the mutual convenience of the school, instructor and ETTC.

Note that your registration is not confirmed until you have received a postcard or other notification from the ETTC. Please call us at 625-6040 if you have any questions.

Thank you for registering for a Virtual Visit. Below please indicate the classroom teacher and technical contact who will be participating in this event. Also, an on-line registration form must be completed for each request - Thank you for your cooperation.

Questionnaire
School Name:
School Address:  (include city and state)
School's Education Contact & Title: (if different from teacher)
Telephone Number:
E-Mail Address:
   
Teacher's Name:
Teacher's Mailing Address: (include city and state)
Teacher's Telephone Number:
Teacher's Email Address:
Connection Number:
Communications Link (IP or ISDN)
Connection Rate (128 Kb/s, maximum connection rate 768 Kb/s):
Description of Videoconferencing Equipment and/or Classroom:
   
Technical Contact:
Telephone Number:
E-Mail Address:  
Date Needed:
Alternative Date:
Time Needed:
Topic Requested:
Description of Target Audience:
Grade Level(s):
Number of Students:
Educational Goal for the Virtual Trip:
Will this activity be used to introduce, continue, or conclude your lesson on the topic?
Additional Comments:

Please Note: Missing information will result in a delay in the processing of your request

Reservations should be submitted at the minimum of 10 business days in advance of the requested date. Again, the ETTC will confirm the details of your distance learning trip by telephone and email. Please call (609) 625-6040 or email ettc@stockton.edu if you have any questions.