UCLA SON Skills Lab Request Form

Quarter Requesting*
Session Frequency*
Select
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Learner Level*

If multiple sessions please include number of student per session or per group

Yes

Please list all rooms the require A/V

Please describe the type of media you will be displaying

6. Request Type*

Please list specific supplies and quantities

Please list specific supplies for each date if different

Include type and quantity

*Simulators for Sim to be assigned by lab staff*

Room Enviornment*
  1. Please describe room set up in detail
  2. Number of stations
  3. Describe each station

Please upload your faculty, visitor & student roster

Please include a copy of the schedule

*inform lab team of changes to these documents*

Drag and drop files here or