SAEL Sim Scheduling Request Form
Upon submission of this form a representative will contact you within 24 hours in a five day work week. Submission of this form does not guarantee requested dates.
Course Faculty Contact:
*
First Name
Last Name
Faculty Contact Email:
*
example@example.com
Date(s) Requested:
*
Time(s) Needed (check all that apply):
*
Full Day
Half Day (Morning)
Half Day (Afternoon)
Evening Hours
Weekend Hours
Other
Select Course
*
Nurs 311
Nurs 312
Nurs 411
Nurs 412
Nurs 422
Nurs 424
Nurs 425
Nurs 431
Nurs 435
Nurs 704
Nurs 712
Nurs 713
Nurs 716
Nurs 723
Nurs 726
Nurs 729
Nurs 730
Nurs 751
Nurs 756
Nurs 757
Nurs 759
Nurs 763
Nurs 764
Nurs 774
Other
Type of Event (check all that apply):
*
Simulation using manikins
Simulation using simulated participants
Virtual Reality Simulation
Other
Name of Simulation
Scenario Name
Number of Rooms Needed
*
Number of Participants Involved in Request (approximate)
*
Please add details or changes needed for the simulation below.
Submit
Should be Empty: