CLSC Booking Form

This field is for validation purposes and should be left unchanged.

Contact Name:(Required)

First Last

Contact Email:(Required)

Contact Phone:(Required)

Facilitator Name

Facilitator Email

Facilitator Phone Number

Organization:(Required)

UPEI Faculty

Health PEI

Other:

Which department?

Which unit?

Is there a research component?(Required)

Yes

If yes, please describe the research component and ethics approval:(Required)

Please indicate the location of the event(Required)

UPEI Clinical Learning and Simulation Centre

In-Situ

Please specify location(Required)

Is there a participant fee associated with this event?(Required)

Yes

Provide a brief description of your simulation activity.(Required)

If in-situ simulation, has a partnership pathway form been completed?(Required)

Yes.

Please attach file

Max. file size: 5 MB.

Has a needs assessment been performed?(Required)

Yes

Please attach file

Max. file size: 5 MB.

Has a simulation session template been completed?(Required)

Yes

Please attach file

Max. file size: 5 MB.

Is this an interprofessional event? (not mandatory question)(Required)

Yes

Expected number of learners

Expected number of simulation rooms required(Required)

Memorial University Faculty of Medicine Learners

CLSC Booking Form

Relevant Links

About Us

Memorial Learners

News & Info

Staff & Faculty

Distributed Medical Education

Medical Labs

Policies & Procedures

Post Grad

Helpful Links

Website Feedback

Clinical Learning & Simulation Centre

About CLSC

Team CLSC

Policies & Procedures

Equipment Catalogue

Quick Links