CEC Scheduling Request Form

I AGREE*
* I have carefully read, understand and agree to abide by the above “Lab Etiquette & Rules.” I understand as the lead instructor for this lab that it is my responsibility to ensure that the participants adhere to the Skills Lab & Simulation Lab Etiquette & Rules. I will review these rules with all participants, and remind them at each class and lab session.

Skill Lab/Simulation Lab Request:

At the close of your session, please return the room to its original configuration and properly dispose of all trash.
Requests must be submitted a minimum of 5 business days in advance.
You will be responsible for providing your own supplies and/or equipment if your request is not received a minimum of 5 business days in advance.
The CEC may not be able to provide non-standard or specialty supplies and/or equipment. Please notify the CEC staff if you are bringing any of your own supplies and/or equipment for your session. Temporary storage may be provided for one week prior and following your session. Advance notice is required for storage.
All debriefing rooms are equipped with a ceiling mounted projector and screen, laptop computer, multiple outlets, tables, and chairs.

Class/Meeting/ Session

Number Attending

Date

Start Time

End Time

GOAL
What would you like the participants to accomplish during this lab activity?

OBJECTIVES
What steps will the participants take to accomplish this?

Clinical Supplies and/or Equipment Request:

Supply “menus” or sets (lists of commonly requested groups of supplies) can be arranged with Skill & Simulation Lab staff, and then requested here by referring to the “menu” or set name.

Special Requests or Additional Items Not Listed Above:

Clinical Education Center at Brackenridge CEC Scheduling Request Form

REQUESTS

Equipment Request:

Equipment Request:

Skill Lab/Simulation Lab Request:

Equipment Request: