< back to For Healthcare Professionals

Simulation Event Request Form

Type of Request

Internal - Erlanger Staff If you selected "Other," please specify: External - Outside Facilities Tour 




Select Classrooms that will be needed: 

If you need any of the Sim Lab Skill Rooms 1 – 4, please indicate which rooms are needed: Name Email: Phone: Organization: Will event be held in the Simulation Center? Title of Event Select Departmental Staff Training Options if Applicable 

If Other, Please Specify: Lead Educator/Facilitator Email: Lead Educator/Facilitator Phone: 

Objectives of Simulation

Objective 1 Objective 2: Objective 3 Objective 4: Objective 5: Number of Participants: Requested Date(s) of simulation events (For each date give Month/Day/Year): Expected Start Time: Expected Stop Time: Expected Set-Up Time: Hands-on/Simulation Activities (please list) Hours of Engagement per Participant: Simulation Staff Needs: 

Standardized Patient Participants Upload your Simulation Event Agenda (PDF or Word document)