Simulation Event Modification Form

Simulation Event Modification Form
Please submit your request six months in advance of your event.

We will review your request and get back to you in a week or so with the next steps in the event modification process.
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
School/Department/Organization*
Event Information
Course Name*
Course Objectives*
Simulation Event Name
Learning objectives for simulation
Requesting modifications to the following (check all that apply):

Event Schedule: Change time at which event is delivered (e.g., month, days of week, time of day, etc.)Checklist and Surveys (e.g., learner performance assessments, program assessment, participant feedback survey)Scenario (i.e., case presentation details for SP or HPS)Simulation Format (e.g., formative, summative, teaching or practice workshop, addition/deletion of equipment and supplies)Other
Please describe in detail the modifications you'd like to make.
Please describe in detail the schedule changes you would like to make.
Please describe in detail the checklist and/or survey changes you would like to make.
Please describe in detail the scenario changes you would like to make.
Please describe in detail the format changes you would like to make.
Please provide any additional details not captured above and attach files if applicable.
Files

Cancelof
Should be Empty:

Event Information