In Situ Request Form

Please provide the following information to use the MUSC Healthcare Simulation Center for an Approved Activity that will be offered off site and for which a New Simulation Activity Request Form is on file. This form must be completed to reserve equipment and support from the simulation center. Please contact us at or (843) 792-1459 for assistance.

Section 1: Contact Information
With area code. No dashes.
With area code. No dashes.
FDM Billing Information
Section 2: Activity Information
Section 3: Sponsor/Participants Information
Check all that apply
Section 4: Activity Schedule
Activity 1
Activity 2
Activity 3
Activity 4
Activity 5
Section 5: Equipment Information
Note: If specific consumables are not available, procurement and reimbursement arrangements must be made between the MUSC Healthcare Simulation Center and the Requesting Unit.