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Event Request Form – Center for Simulation & Immersive Learning
Event Request Form – Center for Simulation & Immersive Learning
Simulation Planning Request
Name
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Last
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Date of Requested Event
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Distance or in Person
(Required)
Program and Course (If Applicable)
Grant Supported
(Required)
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Grant PI
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Learning Objectives (if known, using SMART format)
Simulation Needs (Simulation team can help align the simulation modality) (example: mannequins, Simulated Patients (SPs), task trainers)
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Do you need AV Recording
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Simulation team needs (check all that apply):
Highlight what is needed (if known or indicate unknown.)
Simulation Educator
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Support During the Event
Running a Simulator
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Do you Need to Create a Scenario
(Required)
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Detailed Equipment List (if known, please include equipment purchase requests as well)
Will there be research involved
(Required)
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If yes, do you have IRB or will you be Obtaining IRB
(Required)
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