Providing Leadership in Education

Videoconference Program Request

If you have questions or need assistance completing this form, please contact Josh Bridges at josh.bridges@berrienresa.org or (269) 471-7725x1101.

Only Berrien RESA member schools should use this form. If you're not from a Berrien RESA REMC member school and you want to participate in one of our programs, use this form instead.

Teacher FirstName:
Teacher Last Name:
Teacher Email:
Teacher Direct Phone#: (if different than school phone #)
School:
If your school is not listed, please email josh.bridges@berrienresa.org.
GradeContent:
Number of Students:


Note: Your videoconference will be more enjoyable and interactive for your students if you just take one class (up to 30 students) at a time.
Program: Put the title of the program and the provider (if you know) here.
Content Provider:
or place you're connecting to.
Preferred Time: What time does the class meet? What is the earliest you could do the program? When does the program need to end at the latest? The more information you give, the easier it is to schedule. Please don't write "anytime!" We don't know when your school day starts and ends, when lunch is, or when your recess/breaks are.
Which days of the week are best? (i.e. Mon and Thu):
Give a Range of Dates (i.e. Sept 10-22): Give a range of dates that will work for you, such as a two week window. The more flexible and specific you are, the easier it is to schedule.

Please double check your requested dates against your school's testing, vacation, and events schedules.
Any Special Instructions for Josh or the intern? If you're registering for a project or connection with other classroom(s), please write any extra needed information here.
Cost of Program: Program fee (if any). Please put 0 if none. Otherwise, note that your district is responsible for this amount.
By submitting this form, you agree to follow through on this program, i.e. complete the pre-activities, participate in the program, and do the follow-up activities.