Immersive Learning Center (ILC) Photo Shoot and Filming Request Form
Please submit your request for a photo shoot or filming in the ILC by submitting this form (* indicates required field).
Photo shoots and filming in the ILC are permitted ONLY on weekends by special arrangement and are dependent on staff availability.
Associated costs may apply.
PLEASE NOTE: In observance of the School of Medicine's mandatory Winter Closure, the Immersive Learning Center and Medscheduler will be closed Saturday, December 23, 2017 through Sunday, January 7, 2018. All requests received during that time will be attended to on or after January 8, 2018.
Title of Event (if related to a medical student course, include course number e.g.: INDE 205: EMED or PICU CRM):
Alternative filming dates
Please provide alternative dates in case your first choice of date is not available
Additional filming dates
Set up time
How much time will you need prior to the start time of your event to set up equipment?
Take down time
How much time will you need after the end time of your event to pack up your equipment?
Description of Purpose for Photo Shoot or Filming:
Do you anticipate needing standardized patients/participants for your program?
Please note that there is a cost associated with hiring Standardized Patient actors.
Number of participants
Including faculty, staff, photographers, standardized patients & anyone else who will be on site
Learner Population (list participant/learner level e.g.: 1st year resident):
Name and Title of Requestor:
Email of Requestor:
Phone number of Requestor:
Faculty Lead Name:
Faculty Lead Email:
Requesting department or organization
Other Faculty/Instructors who will be present for the program:
Name of Photographer(s):
Information for invoicing
Some photo shoots and filming projects will have costs associated with the use of rooms, resources or supplies. These costs will be identified prior to charging the PTA/Cost Center listed below.
PTA/Cost Center Approver First and Last name
PTA/Cost Center Approver contact number
PTA/Cost Center approver e-mail
E-mail address of approver for billing of resources/supplies on above PTA.
PTA/Cost Center number
PTA number for billing of resources/supplies
Thank you! Please allow 3 business days for ILC staff to reply to your request.
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