CEC Simulation Request Form

Course/Event

Faculty Name

Contact Name

Company

Phone

Proposed Date of Event

Proposed Date of Event
Proposed Date of Event

Simulation Purpose

Summative

Formative

Teaching

Research

Student Level

Summary/Course Objectives

Summary of Simulation Situation

Learner’s prerequisites (required reading/material review, recorded pre-brief, etc.)

You should not be able to see this field, do not touch.