Simulation Request Form

You can request up to three simulations at a time. If you are teaching more than one section or different classes, fill out a separate form for each section or class.

Contact Information

First and Last Name

Preferred Contact Number

How did you hear about us?

Simulation Information

The form has a limit of three requests. If you have more than three requests, you will need to submit multiple request forms.

First Simulation Request

What is your first simulation date (or approximate date)?

What is your simulation start time?

What is your simulation end time?

It is recommended that simulations are not shorter than two hours.

Department Information

Department

Faculty

Course Code and Title

If requesting in-person delivery, what is the location of your simulation or virtual?

Would you like to use one of the simulations that are already developed in our catalogue or speak to a Writer/Trainer to discuss your options?

LAS has a catalogue of over 100 scenario's to choose from. Please review catalogue and input your catalogue choices here. If you are looking for a custom scenario, select custom. If you are not sure what scenario you want, our trainers can assist you.

How many learners are participating in your simulation?

Who is your Chair/Director/Manager responsible for approval of this request?

What is your Chair/Director/Manager's email address?

Please inform your manager that they will receive a follow-up email to confirm that this booking request is authorized.

Second Simulation Request

What is your second simulation date (or approximate date)?

What is your simulation start time?

What is your simulation end time?

It is recommended that simulations are not shorter than two hours.

Third Simulation Request

What is your third simulation date (or approximate date)?

What is your simulation start time?

What is your simulation end time?

It is recommended that simulations are not shorter than two hours.

If you have more than three simulation requests, please fill out an additional form.

Learning Outcomes and Facilitation Information

Please fill out this section as best you can, and our Trainers will follow up to support your booking request.

What do you hope to achieve with this Simulation? What are your learning objectives?

Are there any particular areas/objectives you would like the simulator to highlight during feedback?

Do you have any additional special instructions?

For example: different setting, changes to simulator role, etc.

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