Course Application

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  • Course Selection & Date

  • Application Form for Simulation Instructor Training

    Please complete the form below to apply for a simulation instructor training course or workshop. You will be informed of your acceptance and next steps by email.

  • Registrant Information

  • Clinical examples might be anesthesia or emergency medicine. A non-clinical example might be organizational behavior. For applicants who are no longer practicing clinically, please tell us your previous clinical background.
  • e.g. Associate Program Director, Fellow in Medical Simulation, Clinical Nurse Specialist, Program Manager of Simulation, Staff Development Specialist
  • e.g. MD, RN, MSN, PhD, EdD, EMT-p, MEd, MPH
  • Contact Information

  • Please enter (and confirm) the best email address to contact you. You will receive a confirmation of this application sent to this address.
  • Please enter the name of your institution, hospital, simulation center, university, or other affiliated organization.
  • Please enter your institution mailing address. (work address)
  • Other Information

  • Please let us know in the space provided below if you have any special requests such as accommodation for severe food allergies. We will do our best to help meet your needs but please understand that we may not be able to accommodate every request. This is especially true for dietary requests due to limitations set by our vendors. If you prefer to bring your own food, we have a kitchen space with a microwave and refrigerator available. We also have a private space that can be used for pumping or administering medication.

    If you wish to attend the same course as another colleague, please indicate your colleague's name here.

  • By submitting your application, you consent to our storage and use of your data per our Privacy Policy and Terms & Conditions.
  • This field is for validation purposes and should be left unchanged.