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 June 23, 2023. After that, please select dates that are at least two weeks in the future.

First choice date: Start Time: End Time:

Second choice date: Start Time: End Time:

Third choice date: 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: 06/09/2023

I have read the SIM-NE COVID-19 Procedures and understand the program requirements.
Date: 06/09/2023

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