Reservation Request Form

Please read the CLASS Center Policies before submitting this form.

Please note: Submission of this form DOES NOT guarantee room availability or project approval. You will receive a confirmation email once the reservation has been finalized.

Thank you,

CLASS Center Staff 
SMHS Clinical Learning and Simulation Skills Center

 

Primary Contact Person
Learners or Participants
To what category or organization do your participants belong? (You may select more than one.)

 

If the desired category or organization is not listed, or if you would like to provide more detail (specialty, affiliation, etc.), please check Other and include that information in the textbox.

 

Event Details
(If only happening once, multiple dates/times below will be interpreted as order of preference.)
Add up to three dates/times, the order of preference running from top to bottom.
Date Start Time End Time
more items
Date Start Time End Time
more items
Please indicate if you are requesting the following
View Exam Room Image
View images for: PSL, HF1, HF2, OR1, OR2, L&D
View Conference Room Image
Event/Project Information
Would you like to publish this project?
Is this part of a grant-funded project?
Would you like your event to be recorded?

Any recordings will take place utilizing the SimCapture Simulation Management software system.
CLASS Center Acknowledgement Agreement

I agree that if I plan to present information/data about this project at meetings or publish information/data about this project in journals, I must notify the CLASS Center via email at of my plans in writing at least 2 weeks in advance of the meeting or manuscript due date. A representative of the center will instruct me whether to include the acknowledgement “From the George Washington University Clinical Learning and Simulation Skills Center, Washington, DC” in the presentation/publication. I also agree to include the CLASS Center faculty and/or educators as presenters or authors as they have collaborated in the design of this project.

I have read the CLASS Center Policies and agree to them.

If there are any changes to any of the information submitted, I will email the CLASS Center at class [at] gwu [dot] edu (class[at]gwu[dot]edu) to inform them of such.

I understand that submitting this form does not guarantee reservation until I receive a confirmation email.

Please type your name here to accept the CLASS Center Acknowledgement Agreement.