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KTLN/COT Videoconference Request Form

NOTE: This form goes to COT in Frankfort, which will distribute it to the appropriate hubs. If you have technical problems with this form, please call Gregg Casillo at (859) 258-7165 or Mike Clark at (859) 258-7254. If you have problems or questions about the conference you are requesting or the network, please call the COT video staff at (502) 564-9411.

Last updated: Wednesday, 10-Nov-2004 08:52:29 EST

Requester Information

This section is for listing the contact person for the requested program—the person who can be called with questions concerning the topic as well as the date(s) and time(s).
All information in this section is required.
Contact Name:
Contact Organization:
Contact Telephone Number:
Contact E-Mail Address:


Program Information

This section is for the actual meeting date(s) and time(s). Please fill out each item as completely as possible.
Program Title:
Date Needed: (For multiple meetings, list the first date needed.)
Start Time Needed: : am pm (Eastern Time)
End Time Needed: : am pm (Eastern Time)

The following information is for multiple meeting dates ONLY.
You may skip to the next section if the meeting is for one date only.
This meeting will occur
(choose the appropriate frequency):		 Day(s) of the week the session will meet
(click all that apply):
Once a week Monday
Every two weeks Tuesday
Once a month Wednesday
Once a month on a specific day Thursday
Once a month on a specific date Friday
An entire semester Saturday
Other recurring dates Sunday

Additional Dates: Use this box to enter all other dates on which this meeting will occur, separated by commas.

NOTE

Connection Information

Note: Put a check mark in the box next to the room(s) you would like to reserve.
KTLN Rooms in Site Code Order—please consult the full site listing for complete room details.
CO-Bell Co For Camp, Department of Corrections, Bell County Forestry Camp, Rt 2, Pineville
CO-Blackburn CC, Department of Corrections, Blackburn Correctional Complex, 3111 Spur Road, Lexington
CO-Central Office G2, Corrections—Central Office, Health Service Building, Basement, Rm G-2, Frankfort
CO-Central Office G7, Corrections—Central Office, Health Service Building, Basement, Rm G-7, Frankfort
CO-Cor Training, LV, Department of Corrections, Correction Training, 312 Whittington Parkway, Louisville
CO-EKCC #2, Department of Corrections, Eastern Kentucky Correctional Complex, #2, US 460 Index Hill, West Liberty
CO-EKCC Parole Bd Rm, Department of Corrections, Eastern Kentucky Correctional Complex, #1, US 460 Index Hill, West Liberty
CO-FK Bush Bldg, Justice Cabinet—Office of General Counsel, 403 Wapping Street, Bush Bldg, Frankfort
CO-FK Career Dev Ctr, Corrections—Central Office, Frankfort Career Development Center, 380 Coffee Tree Road, Frankfort
CO-FK Cor Industries, Corrections—Central Office, Kentucky Correctional Industries, 1041 Leestown Road, Frankfort
CO-Green River CC, Department of Corrections, Green River Correctional Complex, 1200 River Road, Central City
CO-KSP, Eddyville, Department of Corrections, Kentucky State Penitentiary, 266 Water Street, Eddyville
CO-KSR, Parole Bd Rm, Kentucky State Reformatory, 3001 West Highway 146, Room 113B, LaGrange
CO-KSR229-CPTU 129, Kentucky State Reformatory, 3001 West Highway 146, Room 229 and CPTU B 129, LaGrange
CO-Luther Luckett CC, Luther Luckett Correctional Complex, 1612 Dawkins Road, LaGrange
CO-Northpoint Tr Ctr, Department of Corrections, Northpoint Training Center, Hwy 33, Burgin
CO-PeeWee Valley, Department of Corrections, Women's Correctional Institute, Ash Ave., Pewee Valley
CO-Roederer ACR, Roederer Correctional Complex, 4000 Morgan Road, ACR, LaGrange
CO-Roederer Rm 111B, Roederer Correctional Complex, 4000 Morgan Road, Rm 111B, LaGrange
CO-Western KY CC, Department of Corrections, Western Kentucky Correctional Complex, 374 New Bethal Road, Fredonia
DE-Anderson Co HS, Anderson County High School, 750 Broadway, Room 112, Lawrenceburg
DE-Augusta Ind, Augusta Independent, 3107 Bracken Street, Augusta
DE-Ballard High School, Ballard High School, 6000 Brownsboro Road, Rm 220, Louisville
DE-Bardstown HS, Bardstown High School, 400 North Fifth Street, BHS Library KTLN Room, Bardstown
DE-Barren Co HS, Barren County High School, 507 Trojan Trail, KTLN Room, Glasgow
DE-Bath Co HS, Bath County High School, 645 Chenault Drive, Room 214, Owingsville
DE-Bell Co HS, Bell County High School, 25 E. South, Route 1, Pineville
DE-Boone Co BOE, Boone County Board of Education, 8330 US Route 42, Conference Room, Basement, Florence
DE-Bracken Co HS, Bracken County High School, 350 W. Miami Street, Brooksville
DE-Campbell Co HS, Campbell County High School, 25 West Lickert Road, Alexandria
DE-Carroll Co HS, Carroll County High School, 1706 Highland Ave., KTLN Room, 2nd floor, Carrollton
DE-Clay Co HS, Clay County High School, Route 7, Hwy 421, Room 10, Manchester
DE-Clinton Co LC, Clinton County Learning Center, 300 King Drive, Albany
DE-Crittenden Co HS, Crittenden County High School, Highway 60 West, Room 113, Marion
DE-Danville KSD, Kentucky School for the Deaf, 205 South Second Street, Brady Hall, Danville
DE-Dawson Spgs Ind, Dawson Springs Independent, 317 Eli Street, Dawson Springs
DE-E Jessamine Mid, East Jessamine Middle School, 851 Wilmore Road, District Technology Office, Nicholasville
DE-Franklin/Simpson, Franklin Simpson High School, 400 South College Street, Franklin
DE-Fulton City HS, Fulton City High School, 700 Stephen Beale Drive, Fulton
DE-GR Clark HS, George Rogers Clark High School, 620 Boone Avenue, Winchester
DE-Grant Co HS, Grant County High School, 395 School Road, Room 219, Dry Ridge
DE-Heath HS, Heath High School, 4330 Metropolis Lane, West Paducah
DE-Henry Co Middle, Henry County Middle School, 1124 Eminence Road, New Castle
DE-Knox Central HS, Knox Central High School, 311 North Main Street, Library Annex, Barbourville
DE-Lee Co HS, Lee County High School, 599 Lee Avenue, KTLN Room 127, Beattyville
DE-Leslie Co HS, Leslie County High School, Highway 412 South, Hyden
DE-Lewis Co HS, Lewis County High School, 426 Lexington Ave., Room 32, Vanceburg
DE-Louisa Middle, Louisa Middle School, 9 Bulldog Lane, Room 119, Louisa
DE-Magoffin Co HS, Magoffin County High School, 201 Hornet Dr., Library Resource Center, Salyersville
DE-Mason Co HS, Mason County High School, 1320 US 68, Hall 4, Room 406, Maysville
DE-McCreary Co HS, McCreary County Central High School, 400 Raiderway, Room 123, Stearns
DE-Monticello Ind, Monticello High School, 135 Cave Street, Library Media Center, Monticello
DE-Owen Co HS, Owen County High School, 2060 Highway 22E, Vocational Building, Room 1, Owenton
DE-Perry Co HS, Perry County Central High School, 315 Park Ave, Room 241, Hazard
DE-Pike Central HS, Pike County Central High School, 100 Winners Circle Road, Room 4020, Pikeville
DE-Powell Co HS, Powell County High School, 700 College Avenue, Stanton
DE-Raceland Ind, Raceland Independent High School, 500 Rams Boulevard, Room 205, Raceland
DE-Reidland HS, Reidland High School, 5349 Benton Road, Paducah
DE-Russell Co HS, Russell County High School, 2166 S. Highway 127, Room 100, Russell Springs
DE-Shelby Co HS, Shelby County High School, 1701 Rocket Lane, Room 122, Shelbyville
DE-Simons Middle Sch, Simons Middle School, 242 West Water Street, Room 307, Flemingsburg
DE-Somerset HS, Somerset High School, 301 College Street, KTLN Room 13, Second Floor, Somerset
DE-South Floyd HS, South Floyd High School, Route 122, Room 100, Hi Hat
DE-Southgate, Southgate Independent, Blatt and Evergreen Ave., Southgate
DE-Taylor Co HS, Taylor County High School, 300 Ingram Ave., Teleconferencing Classroom, Campbellsville
DE-Union Co PPH, Union County Paul Pie Herron Bldg., 4500 US Higway 60 W, Morganfield
DE-Warren Co SSC, Warren County Support Services Center, 877 Jackson Street, Bowling Green
DE-Williamsburg Ind, Williamsburg Independent, 1000 Main Street, Room 149, Williamsburg
DE-Winburn Middle, Winburn Middle School, 1060 Winburn Drive, Room 34, Lexington
EK-Corbin ITV 1, EKU Corbin Extended Campus, 14892 North US 25E, Room ITV 1, Corbin
EK-Corbin ITV 2, EKU Corbin Extended Campus, 14892 North US 25E, Room ITV 2, Corbin
EK-Corbin ITV 3, EKU Corbin Extended Campus, 14892 North US 25E, Room ITV 3, Corbin
EK-Corbin ITV 4, EKU Corbin Extended Campus, 14892 North US 25E, Room ITV 4, Corbin
EK-Danville ITV 1, Boyle County EKU Extended Campus, 1560 Houstonville Road, Room ITV 1, Danville
EK-Danville ITV 2, Boyle County EKU Extended Campus, 1561 Houstonville Road, Room ITV 2, Danville
EK-Danville ITV 3, Boyle County EKU Extended Campus, 1560 Houstonville Road, Manor Shopping Center, Room ITV 3, Danville
EK-Funderburke 211, Eastern Kentucky University, Funderburke Building, Room 211, Richmond
EK-Library 110, Eastern Kentucky University, Crabbe Library, Room 110, Richmond
EK-Manchester ITV 1, Clay County EKU Extended Campus, 470 Manchester Square, Room ITV 1, Manchester
EK-Manchester ITV 2, Clay County EKU Extended Campus, 470 Manchester Square, Room ITV 2, Manchester
EK-Manchester ITV 3, Clay County EKU Extended Campus, 470 Manchester Square, Room ITV 3, Manchester
EK-Univ Bldg, Rm 135, Eastern Kentucky University, University Building, Room 135, Richmond
EK-Univ Bldg, Rm 136, Eastern Kentucky University, University Building, Room 136, Richmond
EK-Univ Bldg, Rm 137, Eastern Kentucky University, University Building, Room 137, Richmond
EK-Univ Bldg, Rm 139, Eastern Kentucky University, University Building, Room 139, Richmond
HS-Barren River HD, Barren River District Health Department, 1109 State Street, Bowling Green
HS-Central St Hosp MHMR, Central State Hospital CHS/MHMR, 10510 Lagrange Rd., Louisville
HS-CHS, Health Services, Third Floor, Training Room A, Health Services Building, 275 East Main Street, Frankfort
HS-W State Hosp MHMR, Western State Hospital CHS/MHMR, 2400 Russellville Road, Hopkinsville
IP-Covington Rm10, Covington Campus of Northern Kentucky University, 1401 Dixie Highway, Hankins Hall, Room 10, Covington
IP-CPE Room B, Council on Postsecondary Education, 1024 Capital Center Drive, Suite 320, CPE Conference Room B, 3rd Floor, Frankfort
IP-CPE Room E, Council on Postsecondary Education, 1024 Capital Center Drive, Suite 250, CPE Conference Room E, 2nd Floor, Frankfort
IP-EDU201B, University of Louisville (EDU201B), Educational Resource and Technology Center, Room 201B, Louisville
IP-HSK2024, University of Louisville (HSK2024), Health Sciences Campus, The School of Nursing and Allied Health, 500 Preston St., K-Wing, Bldg #24, Rm 2024, Louisville
IP-HSK2035, University of Louisville (HSK2035), Health Sciences Campus, The School of Nursing and Allied Health, 500 Preston St., K-Wing, Bldg #35, Rm 2035, Louisville
IP-JCC Carrollton, Jefferson Community College—Carrollton Campus, KTLN Room, 2nd floor, Carrollton
IP-JCC Downtown, Jefferson Community College—Downtown Campus, 109 East Broadway, Louisville Vocational Building, Room LV-210, Louisville
IP-JCC Jeff Tech, Jefferson Community College, Jefferson Regional Technology Center, 727 W. Chestnut, Room 121, Louisville
IP-JCC Shelbyville, Jefferson Community and Technical College, Shelby County Campus, U.S. 60, 1361 Frankfort Road, Room 131, Shelbyville
IP-JCC Southwest, Jefferson Community College—Southwest Campus, 1000 Community College Drive, Learning Resource Center, Room 200B, Louisville
IP-KCTCS Main Office, KCTCS Main Office, Main Street, Old Texas Instruments Building, Versailles
IP-LUTZ306, University of Louisville (LUTZ), Speed Research Administration, Academic Building, Room 306, Louisville
IP-Maysville CTC/LV Campus, Maysville CTC, Licking Valley Campus, 319 Webster Ave, Cythiana
IP-Maysville CTC/Rowan EC, Rowan Co Technical College, MaysvilleCC/Morehead Campus, 609 Viking Dr, Morehead
IP-MITC202, University of Louisville (MITC202), Miller Information Technology Center, Room 202, Louisville
IP-NKU/Portable Unit, Northern Kentucky University, Nunn Drive, Highland Heights
IP-SK106, University of Louisville (SK106), Belknap Campus, Stricker Hall, Room 106, Louisville
JPS-Atherton High School, JPS Network, Atherton High School, 3000 Dundee Road, Louisville
JPS-Central High School, JPS Network, Central High School, 1130 W. Chestnut Street, Video Conference Room, Louisville
JPS-Eastern High School, JPS Network, Eastern High School, 12400 Old Shelbyville Road, Louisville
JPS-Engelhard Elememtary, JPS Network, Engelhard Elementary, 1004 S. First Street, Video Conference Room 203, Louisville
JPS-Fairdale High School, JPS Network, Fairdale High School, 1001 Fairdale Road, Louisville
JPS-Iroquois High School, JPS Network, Iroquois High School, 4615 Taylor Blvd, Louisville
JPS-Jeffersontown High School, JPS Network, Jeffersontown High School, 9600 Old Six Mile Lane, Louisville
JPS-Male High School, JPS Network, Louisville Male High School, 4409 Preston Highway, Video Conference Room, Louisville
JPS-Meyzeek Middle School, JPS Network, Meyeek Middle School, 828 S. Jackson Street, Video Conference Room 203, Louisville
JPS-Waggener High School, JPS Network, Waggener High School, 330 S. Hubbards Lane, Louisville
KC-Ashland Tech, Ashland Technical College, 4818 Roberts Drive, Room 221, Ashland
KC-Central Ky Tech, Central Kentucky Technical College, 308 Vo-Tech Drive, Manufacturing Building, Room M119, Lexington
KC-CKTC, Danville, Central Kentucky Technical College-Danville, Danville Tech, 59 Corporate Drive, Danville
KC-Etown CC, Elizabethtown Community College, 600 College Street, Learning Resource Center, Room 117, Elizabethtown
KC-Hazard CC Rm 119P, Hazard Community College, One Community College Drive, Highway 15 South, Feltner Center, Room 119P, Hazard
KC-Henderson CC103, Henderson Community College, Academic Technical Bldg, 2660 S. Green St, Room 103, Henderson
KC-Henderson CC208, Henderson Community College, Heckt Lackey Administration Building, Room 208, Henderson
KC-Hopkv CC Rm 204, Hopkinsville Community College, 720 North Drive, Regional Technology Center, Room 204, Hopkinsville
KC-KATI, Kentucky Advanced Technology Institute, 1127 Morgantown Road, Quality Lab, Bowling Green
KC-Laurel Rm 116, Somerset Community College at Laurel Ctr., Rm 116, 100 University Drive, Laurel North Two, Room 116, London
KC-Laurel Rm 118, Somerset Community College at Laurel Ctr., Rm 118, 100 University Drive, Laurel North Two, Room 118, London
KC-Madv CC, Room 14, Madisonville Community College, 2000 College Drive, Joe C. Davis Building, Room 14, Madisonville
KC-Madv CC, Room 249, Madisonville Community College, 2000 College Drive, John Gray Building, Interactive Telecommunication Room 249, Madisonville
KC-Mayo Tech, Mayo Technical College, Industrial Technology Center, Hager Hill Campus, 150 Industrial Park, Room 156, Hager Hill
KC-Maysville CC, Maysville Community College, 1755 US 68, Main Building, Room 226, Maysville
KC-McCreary Ctr, Somerset Community College, McCreary Center Rm 152, 250 College Street, Room 152, Whitley City
KC-Muhlenberg EC, Madisonville Community College Extended Campus, 406 West Everly Brothers Blvd, College Park Building 1, Central City
KC-Owensboro CC R104, Owensboro Community College, 4800 New Hartford Road, Academic Building, Interactive Video Learning Center, Room 104, Owensboro
KC-Owensboro CC R207, Owensboro Community College, 4800 New Hartford Road, Learning Resources Center, Room 207, Owensboro
KC-Paducah CC Rm 101, Paducah Community College, 4810 Alben Barkley Drive, Crounse Hall, Room 101, Paducah
KC-Paducah CC Rm228, Paducah Community College, 4810 Alben Barkley Drive, Crounse Hall, Room 228, Paducah
KC-Paducah WKTC, West Kentucky Technical College, 5200 Blandville Rd, Anderson Building, Room 238, Paducah
KC-Pikeville Tech, Pikeville Technical College, 120 South River Fill Drive, Room N212, Pikeville
KC-Prestonsburg PB1, Prestonsburg Community College, 1 Bert Combs Drive, Johnson Administration Building, Room 132, Prestonsburg
KC-Prestonsburg PB2, Prestonsburg Community College, 1 Bert Combs Drive, Johnson Administration Building, Room 117, Prestonsburg
KC-SE Cumberland 301A, Southeast Community College, 700 College Road, Falkenstine Hall, 301A, Cumberland
KC-SE Cumberland 301B, Southeast Community College, 700 College Road, Falkenstine Hall, 301B, Cumberland
KC-SE Middlesboro Rm 220, Southeast Community College Middlesboro Campus, 1300 Chichester Avenue, Room 220, Middlesboro
KC-SE Middlesboro Rm 239, Southeast Community College Middlesboro Campus, 1300 Chichester Avenue, Science and Technology Building, Room B239, Middlesboro
KC-SE Pineville, Pineville-Cumberland Valley Technical College, 3300 S Hwy 25E, Room 120, Pineville
KC-SE Whitesburg, Southeast Community College, Whitesburg Campus, 201 Long Avenue, Room F/ITV Room, Whitesburg
KC-Somerset AT 102, Somerset Community College, Academic Technology Bldg, Room 102, Somerset
KC-Somerset Rm 111, Somerset Community College, 808 Monticello Street, Cooper Building, Room 111, Somerset
KC-SSCC Clinton Center, Somerset Community College, Clinton Center, Hwy 90, #3, Albany
MH-Ashland L284, Morehead State Ashland Campus, 1400 College Drive, Learning Resource Center, Room L284, Ashland
MH-Ashland L286, Morehead State Ashland Campus, 1400 College Drive, Learning Resource Center, Room L286, Ashland
MH-Breckinridge 217, Morehead State University, Breckinridge Hall, Room 217, Morehead
MH-Combs 211, Morehead State University, Combs Classroom Building, Room 211, Morehead
MH-GH Rm 405, Morehead State University, Winchester Ave., Ginger Hall, Room 405, Morehead
MH-Haz CC Hindman, Morehead Univ—Hazard Community College, Knott County Branch, Opportunity Center, 238 Highway 160, Room 222, Hindman
MH-Jackson 306, Morehead State Unversity at Jackson, Breathitt County Life Skills Center, Room 306, 1127 Main Street, Jackson
MH-Jackson 314, Morehead State Unversity at Jackson, Breathitt County Life Skills Center, Room 314, 1127 Main Street, Jackson
MH-Lappin Hall 121, Morehead State University, Winchester Ave., Lappin Hall 121, Morehead
MH-Lappin Hall 122, Morehead State University, Winchester Ave., Lappin Hall 122, Morehead
MH-Mt Sterling 2, Morehead State Univ EC, Mt Sterling 2, Clay Community Center, 3400 Indian Mound Drive (Corner of ByPass/KY Rt11), Room 120-Classroom 6, Mount Sterling
MH-Mt Sterling 5, Morehead State Univ EC, Mt Sterling 5, Clay Community Center, 3400 Indian Mound Drive (Corner of ByPass/KY Rt11), Room 125-Classroom 3, Mount Sterling
MH-Prestonsburg 129, Morehead State University EC-Prestonsburg, 6 Bert Combs Drive (P.O. Box 1776), Room 129, Prestonsburg
MH-Prestonsburg 130, Morehead State University EC-Prestonsburg, 6 Bert Combs Drive (P.O. Box 1776), Room 130, Prestonsburg
MH-Prestonsburg 230, Morehead State University EC-Prestonsburg, 6 Bert Combs Drive (P.O. Box 1776), Rm 230, Prestonsburg
MH-Reed 247, Morehead State University, Reed Hall, Room 247, Morehead
MH-Reed 325, Morehead State University, Reed Hall, Room 325D, Morehead
MH-West Liberty 205, Morehead State University EC/Licking Valley, 155 Continental Drive (PO Box 190), Distance Learning Lab Room 205, West Liberty
MH-West Liberty 206, Morehead State University EC/Licking Valley, 155 Continental Drive (PO Box 190), Distance Learning Lab Room 206, West Liberty
MH-West Liberty 207, Morehead State University EC/Licking Valley, 155 Continental Drive (PO Box 190), Distance Learning Lab Room 207, West Liberty
MU-AS 205, Murray State University, 103 Applied Science Building, Room 205, Murray
MU-Breathitt Vet Ctr, Breathitt Veterinary Center, 715 North Drive, Hopkinsville
MU-Bus Bldg, Rm 102, Murray State University, 16th Street, Business Building, Center for Continuing Education, Room 102, Murray
MU-Bus Bldg, Rm 104, Murray State University, 16th Street, Business Building, Center for Continuing Education, Room 104, Murray
MU-Henderson Rm13, MSU-Extended Campus Henderson, 328 Seventh Street, Room 13, Henderson
MU-Henderson Rm3, MSU-Extended Campus Henderson, 328 Seventh Street, Room 3, Henderson
MU-Henderson Rm4, MSU-Extended Campus Henderson, 328 Seventh Street, Room 4, Henderson
MU-Madv CC, Room 334, Madisonville Community College, 2000 College Drive, John Gray Building, Interactive Telecommunication Room 334, Madisonville
MU-Mason Hall 214, Murray State University, 14th and Payne Street, Mason Hall, Room 214, Murray
MU-MSU Hopkv Rm 107, MSU-Hopkinsville Community College Extended Campus, West Regional Post Secondary Education Center, 5305 Ft. Campbell Blvd, Rm 107, Hopkinsville
MU-MSU Hopkv Rm 113, MSU-Hopkinsville Community College Extended Campus, West Regional Post Secondary Education Center, 5305 Ft. Campbell Blvd, Rm 113, Hopkinsville
MU-MSU Hopkv Rm 14, MSU-Hopkinsville Community College Extended Campus, Auditorium Building, Room 14, Hopkinsville
MU-Pad, Crisp 100, Harry L. Crisp Sr. Regional Higher Education Campus, 3000 South Irvin Cobb Drive, Room 100, Paducah
MU-Pad, Crisp 102, Harry L. Crisp Sr. Regional Higher Education Campus, 3000 South Irvin Cobb Drive, Room 102, Paducah
MU-Pad, Crisp 106, Harry L. Crisp Sr. Regional Higher Education Campus, 3001 South Irvin Cobb Drive, Room 106, Paducah
MU-Trover Clinic, Madisonville Community College-Trover Clinic, 435 North Kentucky Avenue, Suite A, Madisonville
OT-Carl Perkins Rehab Cntr, Carl Perkins Rehabilitation Center, CDPCRC Bldg., RM F-106, 5659 Main Street, Paintsville
OT-CPE Room A, Council on Postsecondary Education, 1024 Capital Center Drive, Suite 320, CPE Conference Room A, 3rd Floor, Frankfort
OT-Federal Court LV, Federal Court, Louisville, Louisville
OT-Governor Rm 110, Governor's Office, The Capitol, Capital Ave., Press Room 110, Frankfort
OT-KSU Aquaculture, Kentucky State University, Aquaculture, Frankfort
OT-KSU509, Kentucky State University, University Drive, 275 E. Main St., Academic Services Bldg., 5th Floor, Room 509, Frankfort
OT-KSU519, Kentucky State University, University Drive, 275 E. Main St., Academic Services Bldg., 5th Floor, Room 519, Frankfort
OT-KVICC, Kentucky Video Conference Center (KViCC), 101 Cold Harbor Dr, 1st Floor, Frankfort
OT-LRC Rm131, Legislative Research Commission, 700 Capitol Avenue, Capitol Annex, Room 131, Frankfort
OT-LV Science Center, Louisville Science Center, 727 West Main Street, Tech Forum, Louisville
OT-MTEC, Madisonville Technology Economic Center, 755 Industrial Drive, Madisonville
OT-PSC, Public Service Commission, 211 Sower Blvd, Conference Rm1 and 2, Frankfort
SOM-London KYHIC, Kentucky Highlands Investment Corporation, 362 Old Whitley Road, London
SOM-Beattyville/PEP Inc, PEP Inc.-Beattyville, 70 Locust Street, PO Box 285, Beattyville
SOM-Bell Co ATC, Bell Co. Area Technology Center (ATC), RR7 Box 199-A, Pineville
SOM-Campbellsville Univ TTC, Campbellsville University Technology Training Center, 1 University Drive, Technology Training Center, UPO 1343, Campbellsville
SOM-Casey Co Public Library, Casey County Public Library, 238 Middleburg Street, Liberty
SOM-Columbia/Lindsey Wilson, Lindsey Wilson College, 210 Lindsey Wilson Street, Katie Murrell Library, Columbia
SOM-Corbin High School, Corbin High School, 1901 Snyder Street, Corbin
SOM-CRED Boardroom, Center for Rural Economic Development, 2292 US Highway 27 South, Board Room, Somerset
SOM-CRED Classroom, Center for Rural Economic Development, 2292 US Highway 27 South, Second Floor Telecommunications, SCC, Room 205J, Somerset
SOM-Frenchburg, Menifee Public Library, 1555 Walnut Street, Frenchburg
SOM-Garrard Co HS, Garrard Co. High School, 304 West Maple Avenue, Lancaster
SOM-Harlan Indp School, Harlan County Community Learning Center, 420 East Central Street, Harlan Independent School, Harlan
SOM-Harlan SECC, Harlan County Southeast Community College, 164 Ballpark Road, Harlan
SOM-Hazard CC Rm 100, Hazard Community College, One Community College Drive, Highway 15 South, Learning Resource Bldg., Rm 100, Hazard
SOM-Hindman/Knott Co Branch, CenterNET, Hazard Community College Knott Co Branch, 238 Highway 160, 2nd Floor, Hindman
SOM-Inez/Roy F. Collier CC, Roy F. Collier Community Center, 1200 Main Street, Inez
SOM-Jackson Co ATC, Jackson County Area Technology Center, 1000 Education Mountain Drive, P.O. Box 784, McKee
SOM-Jackson/LCC/HCC, Lee's College Campus of Hazard Community College, 1127 Main Street, Jackson
SOM-Jessamine Co LSI, Jessamine Co, Lockmasters Security Institute, 1014 S Main Street, Nicholasville
SOM-Knox Co/Union College, Knox Co-Union College, 310 College Street, Sharp Academic Center, Barbourville
SOM-Lawrence Co AEC, Lawrence County Adult Education Center, 235 Powhatan Street, Louisa
SOM-Leslie Co CDC, Leslie County Community Development Training Center, Hazard Community College Branch Campus, 108 Maple Street, PO Box 1870, Hyden
SOM-Magoffin Co Public Library, Magoffin County Public Library, 435 Church Street, Salyersville
SOM-Manchester/Clay Co Med, Clay County Medical Center, 509 Memorial Drive, Suite 2, Manchester
SOM-McCreary Center, Somerset Community College, McCreary Center, Highway 27 South, PO Box 438, Room 116, Whitley City
SOM-Monroe Co. EDC, Monroe County Economic Development Center, 202 North Magnolia, Tompkinsville
SOM-Owsley Co Action Team, Owsley County Action Team, Old State Route 11 South, PO Box 997, Booneville
SOM-Paintsville HS, Paintsville High School, 2225 2nd Street, Paintsville
SOM-Pikeville Comm Tech Cntr, Pikeville College, Community Technology Center, 119 College Street, Room 134, Pikeville
SOM-Pineville Ind Sch, Pineville Independent School, 401 Virginia Avenue, Pineville
SOM-Prestonsburg MAC, Mountain Arts Center, One Hal Rogers Drive, Prestonsburg
SOM-Rockcastle Co Courthouse, Rockcastle Co Courthouse, Main Street, Mt Vernon
SOM-W Liberty/UK Tech Cntr, UK Regional Technology Center, 150 University Drive, West Liberty
SOM-Williamsburg/Cumberland College, Cumberland College, 7656 College Station Drive, Williamsburg
SOM-Wolfe Co Outpatient Clinic, Kentucky River Community Care, Wolfe County Outpatient Clinic, Hwy 15, Campton
TC-BG District 3, Transportation Cabinet, Dept of Hwys, 900 Morgantown Rd, Bowling Green
TC-DOT IP #1, Transportation Cabinet, Transportation Building, Mero St., IP #1, Frankfort
TC-DOT IP #2, Transporation Cabinet, Transportation Building, Mero St., IP #2, Frankfort
TC-DOT Mero St, Transportation Cabinet, Transportation Building, Mero St., Mero St, Frankfort
UK-B&E, University of Kentucky, College of Business and Economics, Business and Economics Bldg., Room 252, Lexington
UK-CHS 216, UK College of Health Sciences, 900 S. Limestone St, Room 216, Lexington
UK-CHS 219, UK College of Health Sciences, 900 S. Limestone St, Room 219, Lexington
UK-CON EMNet, University of Kentucky Medical Center, Rose Street, College of Nursing Emnet, Lexington
UK-CON102A, University of Kentucky, Medical Center, Health Science Learning Center, College of Nursing Rm 102A, Lexington
UK-CON505, University of Kentucky, Medical Center, Health Science Learning Center, College of Nursing Rm 505, Lexington
UK-Covington Rm11, Covington Campus of Northern Kentucky University, 1401 Dixie Highway, Hankins Hall, Room 11, Covington
UK-Dickey Hall Rm 27, University of Kentucky, College of Education, Dickey Hall, Room 27, Lexington
UK-Dickey Hall Rm 33, University of Kentucky, College of Education, Dickey Hall, Room 33, Lexington
UK-Hazard CRH 218, Center for Rural Health, 101 Airport Gardens Road, CRH#2 Room 218, Hazard
UK-Hazard CRH 220, Center for Rural Health, 100 Airport Gardens Road, CRH#1 Room 220, Hazard
UK-KET, Kentucky Educational Television (KET), 600 Cooper Drive, O.L. Press Telecommunications Center, Rooms 134-135, Lexington
UK-Law Court Room, University of Kentucky College of Law, 1000 University Dr., Law Court Room, Lexington
UK-Law Rm B215, University of Kentucky College of Law, 1000 University Dr., Law Room B215, Lexington
UK-Law Room 213, UK College of Law, 630 S. Limestone St, Room 213, Lexington
UK-Law Room 241, UK College of Law, 630 S. Limestone St, Room 241, Lexington
UK-LCC, Lexington Community College, Moloney Building, Room 109, Lexington
UK-McDowell Ctr, University of Kentucky (McDowell Center), Kentucky Department of the Blind, Charles W. McDowell Center, 8412 Westport Road, Louisville
UK-Midway College, Midway College, 512 E. Stephens St., Little Memorial Library, Room 108, Midway
UK-Robotics, University of Kentucky, Center for Robotics and Manufacturing Systems, Room 309, Lexington
UK-Telehealth #1, University of Kentucky, Telehealth #1, Lexington
UK-Telehealth #2, University of Kentucky, Telehealth #2, Lexington
UK-WT Young, Rm B110, University of Kentucky, WT Young Library, Room B110, Lexington
UL-Telehealth #1, University of Louisville, Telehealth #1, Louisville
UL-Telehealth #2, University of Louisville, Telehealth #2, Louisville
UL-Telehealth #3, University of Louisville, Telehealth #3, Louisville
WF-Bowling Green WFD, Department of Employment Services, Workforce Development—One Stop, 803 Chestnut Street, Bowling Green
WF-Danville WFD, Department of Employment Services, Workforce Development—One Stop, Danville
WF-FK Tech Ed WFD, Workforce Development, Technical Education, 63-64 Wilkerson Blvd, Frankfort
WF-Florence WFD, Department of Employment Services, Workforce Development—One Stop, 8020 Ewing Boulevard, Florence
WF-Frankfort WFD, Department of Employment Services, Workforce Development—One Stop, 275 E. Main St, 2nd Fl., Frankfort
WF-Ft Knox WFD, U.S. Armor Center, Fort Knox, Workforce Development, 1109 C Spearhead Division Road, Room 135, Fort Knox
WF-Georgetown WFD, Department of Employment Services, Workforce Development—One Stop, 1000 W. Main St. Suite 5, Georgetown
WF-Hopkv WFD, Hopkinsville Workforce Development, Employment Services, 110 Riverfront Drive, Conference Room 105, Hopkinsville
WF-Lexington WFD/MTC, Central Kentucky Job Center, Lexington WFD, Mayor's Training Center, 1055 Industry Rd, Lexington
WF-LV 6 & Cedar WFD, DES, Louisville Workforce Development, 600 West Cedar Street, State Office Building, Room 114, Louisville
WF-Prestonsburg WFD, Department of Employment Services, Workforce Development—One Stop, 686 North Lake Drive, Prestonsburg
WF-Richmond WFD, Bluegrass Area Development, Workforce Development, 595 South Keenland Dr., Richmond
WK-AC212, Western Kentucky University, Academic Complex, Room 212, Bowling Green
WK-Cherry Hall 103, Western Kentucky University, Cherry Hall, Room 103, Bowling Green
WK-Etown CC Rm 144A, Elizabethtown Community College, 600 College Street, Room 144A, Elizabethtown
WK-Etown CRPEC 504, Elizabethtown Central Regional Postsecondary Educational Technology Center, University Dr, Room 504, Elizabethtown
WK-Etown CRPEC 509, Elizabethtown Central Regional Postsecondary Educational Technology Center, University Dr, Room 509, Elizabethtown
WK-Ft Knox 101, U.S. Armor Center, Fort Knox Military Base, Building 1174, Room 101, Fort Knox
WK-Ft Knox 301, U.S. Armor Center, Fort Knox Military Base, Building 1174, Room 301, Fort Knox
WK-Glasgow RC 164, WKYU Extended Campus, 500 Hilltopper Way, Room 164, Glasgow
WK-Glasgow RC 166, WKYU Extended Campus, 500 Hilltopper Way, Room 166, Glasgow
WK-Glasgow RC 168, WKYU Extended Campus, 500 Hilltopper Way, Room 168, Glasgow
WK-Grise Hall 137, Western Kentucky University, Grise Hall, Room 137, Bowling Green
WK-MMTH 248, Western Kentucky University, Mass Media and Technology Hall, Room 248, Bowling Green
WK-MMTH 249, Western Kentucky University, Mass Media and Technology Hall, Room 249, Bowling Green
WK-MMTH 250, Western Kentucky University, Mass Media and Technology Hall, Room 250, Bowling Green
WK-Owensboro 106, WKU Extended Campus, 1716 Frederica, Longfellow Building, Room 106, Owensboro
WK-Owensboro 207, WKU Extended Campus, 1716 Frederica, Longfellow Building, Room 207, Owensboro
WK-Owensboro 208, WKU Extended Campus, 1716 Frederica, Longfellow Building, Room 208, Owensboro
WK-Tate Page 109, Western Kentucky University, Tate Page Hall, Room 109, Bowling Green
WK-Tate Page 130, Western Kentucky University, Tate Page Hall, Room 130, Bowling Green
WK-Tate Page 339, Western Kentucky University, Tate Page Hall, Room 339, Bowling Green
In order to make a proper connection, all the sites needed for your program that are not already checked above
MUST be listed in the box below, each on a separate line (this includes your site as well):
Consult the Master Site List for more information.

ISDN Dial-Up ONLY Information

This section is for connectivity outside of the network (and state); please complete all information.
(If you are scheduling a meeting between KTLN rooms, you may go to the next section.)
Non-KTLN
connection needed:		 No Yes
Site Information
Site Name:
City, State:
Technical Contact:
Technical Contact Phone:
Technical Contact E-Mail:
Connection Speed: 384Kbps or 2x64 Kbps
Connection Type: Bonding Mode 1
Communications Protocol: H.221 (ITU Standards) HDLC (VTEL)
Audio Algorithm:
64K G.722 64K G.711u
32K G.721 16K G.728

Billing Information

ATTN:
Telephone:
Organization:
Address:
City:
State:
Zip:
For State Agency Use Only:
COT Billing #: -
State Agency Account Number:

NOTES

Other Information:

(NOTE: This form goes to COT in Frankfort, which will distribute it to the appropriate hubs and sites.)

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