Epic Virtual Training Student Information Form

Epic Virtual Training Student Information Form

Please fill out the below fields so we can better assist you with your Epic virtual training experience.
Name*

First NameLast Name
Email*
example@example.com
Day of Training Contact Phone Number*

Area CodePhone Number where you can be reached during training
Manager/Supervisor Name*

First NameLast Name
Manager/Supervisor Email
firstname.lastname@promedica.org
Completing the following questions will assist the Epic training team anticipate any technology issues or restrictions.

IT IS HIGHLY RECOMMENDED TO COMPLETE YOUR VIRTUAL TRAINING FROM A PROMEDICA FACILITY. CONTACT YOUR MANAGER TO LOCATE A WORKSTATION BEFORE YOU PLAN TO LOG IN FROM HOME DUE TO TECHNOLOGY ISSUES.
Where will you be signing in for virtual training?*

HomeProMedica FacilityNon-ProMedica Facility (Ex: Starbucks, Library, UTMC)Not sure, I am going to check with my manager
Type of PC?*

WindowsMACChromebookOther
Type of Internet access?*

CableSatelliteHotspotDSLOther
How do you plan to connect to the training audio?*

Through my computer with headphones/speakersHome - LandlineCell phoneOther
Any concerns or questions in regards to accessing your virtual training session?
Should be Empty: