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Simulation in Motion-Nebraska Training Session Request Form

We are excited to get back out on the road to offer high fidelity, in-person/onsite simulation training. SIM-NE will continue to offer online/virtual trainings as well. Be sure to distinguish which training you are requesting (virtual/online or in-person/onsite).

SIM-NE's COVID-19 Procedures and general User Guide are available below. Review and acknowledge the documents to complete your training request.

A member of the SIM-NE team will reach out to you within 5 business days to discuss the details of your request.

Thank you for your training request and we look forward to seeing you soon.

*All Fields are Required

Name of agency requesting training:

Specific address of facility where the training will take place:

City where the training will take place:

County where the training will take place:

Contact Person (first/last name):

Telephone (including area code):

Email:

Best way to contact:
     Telephone
     Email

Best time/day to contact:

Method of training being requested:
     Virtual/Online (Zoom)
     In-Person/onsite


The first date available is May 5, 2024. After that, please select dates that are at least two weeks in the future.


First choice date: Calendar Start Time: End Time:


Second choice date: Calendar Start Time: End Time:


Third choice date: Calendar Start Time: End Time:


Time Zone:
     Central Time (CT)
     Mountain Time (MT)

Estimated number of attendees:

Additional comments for program staff (optional):

I have reviewed the SIM-NE user guidelines and understand the program requirements.
Date: 04/21/2024

I have read the SIM-NE COVID-19 Procedures and understand the program requirements.
Date: 04/21/2024

Type the text on the left
into the space below.

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