ILC Change Request Form

PLEASE NOTE:

This form can be used for changes to course time or date, addition or subtraction of rooms or resources, and alterations to course set up/take down time for events in the Immersive Learning Center (ILC).
All programs must be finalized two weeks prior to the scheduled program date.
Change requests made with less than two weeks' notice will not be accommodated.

ILC Hours of Operation: 7:00am-5:30pm Monday through Friday (including setup and takedown) - Evenings and Weekends by Special Arrangement

Course/event name*

Confirmation number*

This number is located on the booking confirmation form that was sent to the requestor and lead faculty (e.g. 2023-ABCDEF)

Requestor name*

Requestor email*

Currently scheduled date that you would like to make changes to*

Please enter the date (MM/DD/YY) that you would like to make changes to. If these changes apply to multiple dates, list every date affected. If you are adding an additional date, please enter "Add date".

Additional dates to change

If you would like to cancel any dates, these must be submitted separately through the cancellation form: https://app.smartsheet.com/b/form?EQBCT=3f95cf18a69e4caa9850bf12b83532e0

New or added course date*

Enter your new date request (MM/DD/YY), followed by the start and finish time. If you are only changing the rooms, resources or set up/take down time, enter N/A

Additional new dates

Enter additional new date request/s (MM/DD/YY), followed by the start and finish time

Describe the change

Enter any relevant additional information about the change. For example: change of start/end time, change of headcount, addition of room or resource, added session, etc.

Reason for change*

Select or enter value

Does your course require or involve one or more Standardized Patient (SP) actors, US models, nurses, proctors, or contingent staff members?*

Note: As per our SP Program policy, if an event is being canceled within 14 days of the scheduled date, all SPs/contingents must be paid in full for the hours that they were originally booked

Select or enter value

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