New Event Proposal

Requestor Contact Information

Full Name*

Email*

Phone Number*

Job Title*

Other faculty or staff involved with event planning

Full Name*

Job Title*

Have you met with administration in your department about implementing this event?*

Have you met with SP Program about implementing this event?*

How will this event be funded?*

Event Description*

Event Name*

Event Location*

Desired Event Date*

Additional Dates*

What are your overall goals for this event?*

How many participants do you anticipate?*

What level of learner?*

Will video recording be needed?* Recording capabilities are limited. SP Program will work with you to accomodate your needs but will not be guaranteed.

Is there any other information you would like to share?*

If Simulation equipment is required, please refer to the Request An Activity section within the Clinical Simulation page located here: Link

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Requestor Contact Information

Other faculty or staff involved with event planning