BRCHS Lab Request Form

Please complete and submit this form to skillslab@ju.edu. Please also send Standardized Patient (SP) requests to skillslab@ju.edu.

Course requests must be submitted in advance of the designated deadline. Finalized dates and times for scheduled courses will be communicated within four weeks of receipt of request.

Faculty Name Faculty Name * First Last
Faculty Email *
Course *
Specific Date(s) and Time(s) Requested *
Describe specific plan for requested lab time (i.e., covered topic, simulation activities & objectives, etc.).
Total students in course
# stations or groups
Minutes per station
Pre/post debriefing time
# course faculty participating
# needed lab instructors
Anticipated role of lab instructor(s) (i.e., demo, proctor, run station, etc.)
Specific set-up needed
Specific equipment & supplies needed
Number of Standardized Patients (SPs) needed

Please complete a Standardized Patient request form.