Policy and Procedure
Simulation Lab Request Form
In order to meet your simulation needs, please fill out the form and return it promptly.
Thank you.
Name of Organization _________________________________________________________
Contact person ______________________________________________________________
E-mail address _______________________________________________________________
When would you wish to use the simulation lab? How long will you need the simulation lab? Please list alternative dates as well.
_____________________________________________________________________________
_____________________________________________________________________________
What simulation scenario(s) will be utilized during this experience? Will you need to utilize one of informatics systems with the scenario (paper, electronic database)?
______________________________________________________________________________
______________________________________________________________________________
Please describe the personnel participating in this simulation experience.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Please review the Policy and Procedure Manual located on our website at www.ccri.edu/simulation/policy-procedure/
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