Simulation Space Reservation Form Simulation Space Reservation Form Please provide your contact info: Your Name: * Department: * University Email: * Campus Phone: * Which simulation space do you wish to reserve? Select all that apply: * Mitchell Scenario rooms/Debriefing (M6NE) Mitchell Presentation/Debriefing (S038) Mitchell Presentation/Debriefing (S029) Mitchell Simulation Lab (P036) Mitchell Virtual Simulation (P121) MARP (R-013) Details of your event: Briefly describe the purpose of your event: * Please provide dates for your event (please provide multiple options as other simulation events may be scheduled): * Who are the participants/learners using the simulation space? (Select all that apply) * Medical students Interns Residents/Fellows Faculty Nurses Other If other level of participant, please describe: Number of Expected Participants: * Equipment needed. If none, please state. * Agreement All requests for the use of the University of Chicago Simulation space must be affiliated with the University of Chicago Medicine, Biological Sciences Division, or University of Chicago. As a custodian for space that belongs to the Simulation Center, I will ensure that only those persons affiliated with my event use it appropriately and responsibly. At the conclusion of my event, I will ensure that the facilities are returned to their original condition. I understand that food and drink (other than water) may not be used in the simulation labs. Food and drink may be used in conference/debriefing rooms. Please note that all images, photographs, video, or audio produced by simulation space, equipment, and/or services is the property of the University of Chicago and may not be used outside of the simulation space without express written consent. * I agree to these terms. If you are human, leave this field blank. This form is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply. Submit Share this:TwitterLinkedIn
