CELS Reservation Request Form

Additional Forms and Agreements

We need the Simulation Scenario Template completed at the time of the reservation request with an ACCURATE equipment list. We cannot guarantee the availability of equipment that is not on the reservation. If in doubt please arrange phone call or meeting with simulation center staff.

For all users using simulations (Example Scenario)

For EXTERNAL users

For INTERNAL users

Please use this form to schedule time at the Center for Experiential Learning.
  • Room reservation request questionnaire

    **If this is a new activity, the request may require a consultation with the CELS staff. ** With each simulation activity that is scheduled, we need to obtain information about the following requirements. All Request for simulation include Simulation Technologist support and designated debriefing room.
  • :
  • :
    live streaming is a video relay that allows participants to view simulations in real time in an alternate location
  • Drop files here or
    Please upload the simulation scenario, with flow chart, and script to be used during your session.
  • Note- there are several adult simulators that may be used almost interchangeably.

  • list "n/a" if not applicable
    An individual other than the patient, who is scripted in a simulation to provide realism, additional challenges, or additional information for the learner, e.g., paramedic, receptionist, family member, laboratory technician
  • Include the NAME of the case and provide a description. If not applicable list "n/a".
  • RESEARCH COMPONENT

    If you think your simulations may have a research component now or in the future, please select "Yes" or "Maybe" to the Research question.
  • If yes, please describe in text box. If not applicable list "n/a".
    Potential researchers need to meet with us a minimum of 12 weeks in advance.