Simulation Space Reservation Form

If you are human, leave this field blank.

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) *

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.

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Simulation Space Reservation Form

Agreement

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