Complete this form in its entirety, filling all applicable and required fields.
Upon submission of your scenario development form you will receive a case ID number to identify your case on this form.
Note: The primary contact will receive the submission confirmation email upon submission of this form and all subsequent booking confirmations. The primary contact will also be cc'ed on all billing related communications sent to the budget contact.
Participant and Faculty Information
Note: As a courtesy to other programs and concurrent events please request only the rooms which are needed. If you are uncertain regarding your needs please provide as much detail as possible in the 'Additional Room Request Details' section.
Simulation Details (If Applicable)
If you have completed a Simulation Scenario Development form please include the case ID here to ensure that the activity is linked with the case. Your case ID was included on your submission confirmation email.
Standardized Patient Details (If Applicable)
If you have completed an OSCE Scenario Development form please include the case ID here to ensure that the activity is linked with the case. Your case ID was included on your submission confirmation email.
Task Trainer Details (If Applicable)
Medical Equipment Details (If Applicable)
Consumable Supplies (If Applicable)
Consumable supplies are supply items that are used and then discarded and include items such as gauze, syringes, procedural trays and single use mannequin inserts.
Please provide a detailed list of all supplies required below. You may also paste free text or upload a list of supplies needed. Acceptable documentation must include number and description of each supply and may be in Excel, Word, or PDF format.
Quantities are total. Please specify how they should be distributed either in your case documentation or free text entry below.
Agree and Submit Your Request
Review the documents below prior to submitting your request. These documents govern the use of the Augusta University Interdisciplinary Simulation Center and by submitting this request you agree to abide by the rules of the ISC and also agree to ensure compliance by your participants and faculty. All participants and faculty in your activity must sign a Code of Conduct Acknowledgement and AV Release prior to their activity. A copy of these documents will accompany your request confirmation.