VHCC Simulation Lab Rental Request | Virginia Highlands Community College

Thank you for your interest in the VHCC Simulation Lab.

Please complete the form below, and we will contact you with more information as soon as possible. If you have any questions regarding the form, please contact the Simulation Lab Coordinator, Bethaney Hilt, at bhilt@vhcc.edu.

Organization/Agency Name

Contact Person

Phone Number

Email Address

Mailing Address

Billing Contact (if different)

Tax ID Number (if applicable)

Requested Date(s) & Alternate Date(s)

Number of Participants

Current Participant Credentials (RN, LPN, CNA, EMT, etc.)

Number of Instructors Attending

Simulators Requested

Adult Male

Adult Female

Pediatric Male (5-12 years old)

Newborn

Geriatric Male

Geriatric Female

Obstetric Labor and Delivery

Unsure

How many simulators will you need?

Simulation Scenario(s) to Be Used

Will your agency provide its own curriculum/scenarios?

Yes

Unsure

Will you be providing consumable supplies?

Yes

Unsure

Any additional information we should know about your request?