Community College of Rhode Island

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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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Last Updated: 11/26/14