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Hospitals
Types of ResourcesSimulation Event Request Form
Type of Request
Internal - Erlanger Staff
If you selected "Other," please specify:
External - Outside Facilities
Tour
Participants/Learners
Staff
Students
Select Classrooms that will be needed:
If you need any of the Sim Lab Skill Rooms 1 – 4, please indicate which rooms are needed:
Name
Email:
Phone:
Organization:
Will event be held in the Simulation Center?
Title of Event
Select Departmental Staff Training Options if Applicable
If Other, Please Specify:
Lead Educator/Facilitator Email
Lead Educator/Facilitator Phone:
Objectives of Simulation
Objective 1
Objective 2:
Objective 3
Objective 4:
Objective 5:
Number of Participants:
Requested Date(s) of simulation events (For each date give Month/Day/Year):
Expected Start Time:
Expected Stop Time:
Expected Set-Up Time:
Hands-on/Simulation Activities (please list)
Hours of Engagement per Participant:
Simulation Staff Needs:
Standardized Patient Participants
Upload your Simulation Event Agenda (PDF or Word document)