Simulation Center Room Request Form
Contact Person: ______________________________________
Department/Program: _________________________________
Phone: ________________ Email: _________________________
Event/Class: ___________________________________________
Lead Instructor: _______________________________________
Number of Students: _________ Number of Instructors: _____
Dates of Event:
Day of Week
Date
Start Time
End Time
Rooms Requested
Which simulator(s) do you need? Circle all that apply.
Sim Man 3G
Sim Man Sim Mom Sim Jr. Sim Baby Sim NewB
Is this a new event? Yes No If Yes, when can we schedule a
planning meeting? _________________________________________
Note: Please print out fill out and either scan back in and send to: [email protected] or
college mail to: Kerry Markey-Cote Health Sciences bld room: 3217.