Rural SimCenter Reservation Request

Rural SimCenter Reservation Request

This form is required to schedule time at the Rural simCenter.

You will receive confirmation of the date when it is reserved.
When approved, your session will be listed on the calendar.

Please remember this form is only a request.

Educator requesting time *

Agency Affiliation *

e-mail address *

additional email

Date you are requesting *

Start time requested *

end time requested *

scenario request *

I plan to use a scenario that I have used in the past.

I plan to write a new scenario for this course.

I would like help creating a scenario.

If using an existing scenario(s)please list the title(s):

Please estimate the number of students you expect will attend

The Rural SimCenter keeps with the best practice in simulation education which includes limiting group size to no more than 10 participants. Our space is designed to accomodate groups of 10 students or less.

I plan to use the following manikins:
(Please choose no more than 2) *

I plan to use the following equipment*:

*If specialized equipment is required please check to determine equipment availability with the technologist.

i would like to schedule a live actor

Yes

If an actor is requested, please list the actor casting description.

We have a very limited ability to procure actors but will try in every case to comply with your request. In some cases a scenario may require a specific actor type to reach the scenario objectives. We ask you to be prepared to use a manikin as back up.

Unless otherwise stated the event will be held at:

The Rural SimCenter
560 Cohasset Road
Chico, CA 95926
Please call us at 530-332-5091 or 530-518-9568 if you have any questions.

I am requesting an "off site" event.

Yes

if yes, please list the location details

Please use the space below to provide additional information or to ask questions:

PLEASE READ: Because scenarios require advanced planning and programming we ask that Simulation Educators submit the simulation scenarios in the Rural SimCenter Template six weeks in advance of the scheduled event. We only accept scenarios in the official Rural SimCenter template. Please contact us if you have any questions. If we do not receive your scenarios six weeks in advance your simulation time may be cancelled.

If you need to cancel this request, please contact us at least 6 weeks before the scheduled event.

* = Input is required

Rural SimCenter Reservation Request

This form is required to schedule time at the Rural simCenter. You will receive confirmation of the date when it is reserved. When approved, your session will be listed on the calendar. Please remember this form is only a request.

This form is required to schedule time at the Rural simCenter.

You will receive confirmation of the date when it is reserved.
When approved, your session will be listed on the calendar.

Please remember this form is only a request.