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Clinical Learning and Simulation Centre

Session Booking Form

This form must be completed  6 – 8 weeks prior to your planned learning activity.
This does not guarantee that your program will be scheduled in, but it allows us to see if there are resources and time slots available for your activity.  Please note that filling out the form does not confirm your activity has been approved. You will receive a confirmation email upon approval.

Please submit a separate booking form for every activity you wish to schedule at the CLSC.

Please answer all of the questions as best as you can, and if unsure of what to input, please select/type ‘unsure’ and you will be contacted if necessary. (* denotes a required field)




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Session Instructor* Affiliation, Faculty or Company*

Resources and Equipment*
Check all that apply:




Are you planning to use any of your own equipment?:


Rooms Required*
Check all that apply:








Do you require video recording?*:

Assessment of Learner Performance*:






 Feedback from the learner*:





Research Component*:

Is there any Industry Involvement in this session?*:

Please select the areas that you require assistance with*:







Is catering required?*:

Additional Notes


The information on this form is collected under the authority of the Memorial University Act (RSNL 1990 Chapter M-7) and is needed to process your request. The information will be used in connection with room bookings for the Faculty of Medicine’s Clinical Learning and Simulation Centre (CLSC). If you have any questions about the collection and use of this information, contact the reception desk of the CLSC at CLSC@med.mun.ca or 709 864 6322.

 
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