The code block below illustrates how one might use # and // as comments in your logic and calculations.

This value you provided is not a number. Please try again.

This value you provided is not an integer. Please try again.

The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range

The value you provided is outside the suggested range

This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

This field must be a 10 digit North American phone number (like 415 555 1212). Please re-enter it now.

This field must be a valid email address (like joe@user.com). Please re-enter it now.

The value you provided could not be validated because it does not follow the expected format. Please try again.

Required format:

6nEdXikPwfHzZr5orEXAvXwUP3YpuidId54yI

ILC Reservation Survey

This survey is how faculty request to host a simulation in the ILC and/or standardized patients for ILC simulations. Once you complete the survey, the ILC manager may follow-up with any questions and if the ILC is available on the date and time requested, the ILC manager will reserve the ILC for your simulation in 25Live. Feel free to email the ILC Manager, Christy Hunt (chunt@wcupa.edu), with any questions.

Event Name

* must provide value

Course Name/Number

* must provide value

Faculty Lead Name

* must provide value

Faculty Lead Email Address

* must provide value

Date of Session

* must provide value

Y-M-D

Time of Session (start and end time)

* must provide value

Rooms Requested (select all that apply)

* must provide value

Simulation Rooms

Assessment Lab

Exam Rooms

Debriefing Rooms

ALL

Description of Session

* must provide value

Expand

Do you plan to utilize manikins?

* must provide value

Yes

reset

If YES, How many manikins are you requesting?

* must provide value

If YES, have you run a simulation with a manikin before?

* must provide value

Yes

reset

Do you plan to utilize standardized patients (SPs)?

* must provide value

Yes

reset

Is YES, how many SPs?

* must provide value

Do you have specific SPs that you would like to utilize for the session?

* must provide value

Yes

reset

If YES, please include the following: Name, Email, Phone Number

If YES, would you like the Dean's office to recruit SPs for your simulation?

* must provide value

Yes

reset

If YES, how many SPs are you requesting from the Dean's office? What characteristics are you looking for in the SP (e.g., age, gender, student or community member, etc.)?

* must provide value

Expand

If NO, have you already recruited your SPs? Please provide the SP's full name, email, and phone number

* must provide value

Will the session be recorded?

* must provide value

Yes

reset

Any additional information that could be helpful to the scheduling/ facilitation of this session?

* must provide value

Expand

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.