BRCHS Lab Request Form (2025)

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.

Please send an email to skillslab@ju.edu with all pertinent attachments (including but not limited to relevant rubrics, NLN Simulation templates, specific supplies, or requests).

Faculty Name Faculty Name * First Last
Faculty Email *
Course Name and Number *
Cohort *
Specify Cohort (if Other or Combined was selected in "Cohort" dropdown)
Term *
Specific Date(s) and Time(s) Requested. *
Alternate Dates
Please provide alternate date options if possible. Are you requesting to come during the classes assigned class time? It may not be possible to squeeze in the experience during a short period of time. We will try to work with you on logistics to accomplish the goals of the experience, for our students to be successful and receive a quality experience.
Are you requesting Supplies Only?

Are you requesting Supplies Only? Yes No
Describe specific plan (if known) for requested lab time (i.e., name of simulation, covered topic, simulation activities & objectives, etc.) or desire to work with STAR Center team to develop activity. If requesting supplies only, please list specific items desired and identify when you plan to pick up the supplies.
Total students in course
# stations or groups
Minutes per station
Pre/post debriefing time
# faculty participating
Name(s) of other Faculty Participating
Email of other Faculty/Adjunct Participants
Anticipated # of lab instructors needed
Anticipated role of lab instructor(s) (i.e., demo, proctor, run station, etc.)
Please confirm whether this sim/event is required in the course. *
Specific set-up needed
Specific equipment & supplies needed
Number of Standardized Patients (SPs)/Patient Actors needed

Please complete a Standardized Patient request form.
Please send an email to skillslab@ju.edu with all pertinent attachments (including but not limited to relevant rubrics, NLN Simulation templates, specific supplies, or requests).

Please send an email to skillslab@ju.edu with all pertinent attachments (including but not limited to relevant rubrics, NLN Simulation templates, specific supplies, or requests). Yes I will send attachments via email.