WVU :: School of Medicine :: Clinical Simulation Center

West Virginia University, Robert C. Byrd Health Sciences Center

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STEPS Room Scheduling Request

PLEASE NOTE:

We require requests to be submitted one week in advance. Requests are filled on a first come, first serve basis with curriculum required classes and examinations taking priority. Submission of this form does not guarantee reservation. A confirmation email, possibly requesting additional information, will be sent to you. Class and debriefing rooms are for use with simulation only.

( Required Fields are denoted by the * symbol )


* Contact Person:
* Simulation facilitator:
* Email address:
* Phone:
Beeper or alternate phone#:
* Department:
PO Box:
* Educational activity:
Single Occurrence Event
Date:
Time:
Event Series or Class (maximum of 12 month period)
Days (s):	Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Begin Date:
End Date:
Time:

* No. of people attending:
Will you be recording the event:	Yes No

* Room Request

* Simulator Request

I will be responsible for the setup prior to the activity.

Yes No

I will require technical assistance to run the event: Yes No

Please Explain:

Additional comments or information:

Robert C. Byrd Health Sciences Center
P.O. Box 9101 | Morgantown, WV 26506-9101