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. This form is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply. Submit Share this:TwitterLinkedIn
