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Kan-ed Network Operations Center
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Request for Service - Information:
Institution Name*:
Address*:
City*:
State*:
Zip*:
Contacts:
Administrative Contact
Name*:
Address*:
City*:
State*:
Zip*:
Phone*:
Alt. Phone:
Fax:
Email*:
Technical Contact
Name*:
Address*:
City*:
State*:
Zip*:
Phone*:
Alt. Phone:
Fax:
Email*:
Other Contact
Name*:
Address*:
City*:
State*:
Zip*:
Phone*:
Alt. Phone:
Fax:
Email*:
Membership / Affiliation:
Are you a member of a service consortium?
YES Specify:
NO
Check this box if you would like to become affiliated with a consortia
Unsure
Video Equipment:
Do you have video equipment?
YES
NO
What protocol does it use?
H.323
JPEG
MPEG
Other
Local Network:
Do you have a Local Area Network?
YES
NO
Describe your LAN
Please provide a brief description of your Local Area Network (LAN). Please include information such as: equipment types, connection speeds, infrastructure configuration including firewalls, etc.
Equipment Location (demark):
Address:
City:
State:
Zip:
Building:
Room:
Network Info.:
Router Model:
Connection Speed:
(kbps)
Connection Type:
[ SELECT ONE ]
ATM/IMA
Serial or T1
Frame Relay
Service Provider(s):
Please indicate all that apply.
Provider 1:
Service Type:
[ SELECT ONE ]
Internet
Phone / Voice
Wireless
Other
If Other, specify service
Name:
Address:
Phone:
Provider 2:
Service Type:
[ SELECT ONE ]
Internet
Phone / Voice
Wireless
Other
If Other, specify service
Name:
Address:
Phone:
Provider 3:
Service Type:
[ SELECT ONE ]
Internet
Phone / Voice
Wireless
Other
If Other, specify service
Name:
Address:
Phone:
Kan-ed Network Services:
Select services you are interested in receiving from Kan-ed
Interactive Distance Learning (IDL) [
more info
]
Scheduling for IDL (Renovo) [
more info
]
Multi Point Control Unit (MCU) [
more info
]
Point to Point single event video conferencing [
more info
]
Internet 2 [
more info
]
Other
Activation:
These services should be active by
(DD/MM/YYYY)
Notes:
Please indicate in this area any additional information or notes you want to include. For instance, many hospitals may want to make us aware of the other hospitals that they want to communicate with, or a school may want to indicate those schools that they are already doing IDL with, etc. If you have already chosen a service provider, please note it here.
Questions, comments:
my@kanren.net
