Classroom Request Form

The Central Virginia Center for Simulation and Virtual Learning staff reserve the right to change reserved resources based on overall need.

Facilitators are responsible for the following:

Communication with learners
Maintaining any equipment while in use
Restoring room to original design when completed with a class

First name

Last name

Email address

Name of course

Dates Requested

Start time

End time

Number of students

What time does the room need to be available to you for setup?

Account

Centra (Hospital based)

Centra College of Nursing

Centra Family Practice Residency

Central Virginia Community College

University of Lynchburg (Nursing)

University of Lynchburg (DPT Program)

Other…

Room Preference

Debrief room (seats 12, 2 available)

Debrief room (seats 8, 6 available)

Conference room (seats 6)

Large classroom (seats 48)

Patient rooms without manikins

Other…

Please list all non-disposable equipment needed (ex. ventilator, glucometer, etc.)

The Central Virginia Center for Simulation and Virtual Learning staff reserve the right to change reserved resources based on overall need.

Facilitators are responsible for the following:

Communication with learners
Maintaining any equipment while in use
Restoring room to original design when completed with a class