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Mississippi Academy for Simulation Training
Mississippi Academy for Simulation Training
Mississippi Academy for Simulation Training Home
MAST Onsite Student Group Simulation Request Form
MAST Faculty Online Foundations Training Request Form
Main Content
MAST Onsite Student Group Simulation Request Form
*
= Required Fields
Simulation date
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Simulation time
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Dry run date
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Dry run time
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School
*
Delta State University
Hinds Community College
Holmes Community College
Itawamba Community College
Meridian Community College
Mississippi College
Mississippi University for Women
Mississippi Gulf Coast Community College
Northeast Mississippi Community College
Pearl River Community College
Southwest Mississippi Community College
University of Mississippi School of Nursing
Jones Junior College
Belhaven University, School of Nursing
Alcorn State University, School of Nursing
Coahoma Community College
East MS Community College
Course number
*
Semester
*
Learning Gap (include needs assessment info and course objectives to be met)
*
Number of students/groups (describe plan to run groups through)
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Lab room(s) (med/surg, ER/ICU/OR, clinic)
*
Scenario(s)
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Requested by
*
Requester email
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Requester phone
*
(
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Additional needs
Scenario template
*
*.txt,*.doc,*.docx,*.xls,*.xlsx,*.pdf, *.gif,*.jpg,*.jpeg,*.bmp,*.png,*.tif,*.tiff