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Health Sciences Lab Request Form
Instructions: Please fill out this form to request space and time for your lab activity or simulation.
Send to email: blinnsimcenter@blinn.edu
Requests should be submitted two weeks prior to the requested date.
Please submit one lab request for each lab visit, setup, or content area.
Standardized patient requests may be coordinated through sami.rahman@blinn.edu.
Date Requested
Date(s) Needed
Faculty Name
Office Phone
Email Address
Course Name
Number of Students
Hours Requested
From
To
Number of Beds Needed with Simulators
Empty Beds
Content / Skills Being Performed, Taught, or Objectives
Equipment Needed
Simulator (check gender and number of each)
Other Supplies Needed
Specific Set-Up Instructions (provide in-depth detail to what you need or want, e.g. wounds, clothing, make-up, moulage)
Number of Students per Bed Area
Attach any other documents necessary separately