Qualtrics Survey | Qualtrics Experience Management

Name Of Requestor:

Phone Number:

Email:

Date(s) Requested:

Simulation Center Site Preference:

Cook Hall, RU Main Campus
Roanoke Higher Education Center

Learner Group Description:

Department: (A fee may apply to external users outside of the School of Nursing)
Level:
Course Number:

Number of Learners:

Goals for Case(s):

Audio Visual Needs:

Live Viewing
Recording & Playback Capability
None Needed

Will you be sending faculty to conduct the simulation and debriefing?

Yes
No
Maybe

Please indicate several dates and times you are available to meet with the Director, Simulation Faculty, and/or Program Manager to discuss details of your request. Include ability to meet in person at the center or virtually.