Request Form

ExCEL Request Form For:

  • Clinical Skills Center/Standardized Patients
  • Fresh Tissue Laboratory
  • Simulation Center

*indicates a required field

Please note:

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- If a confirmation screen does not appear after clicking the 'Submit Form' button, the form has not been submitted.


Event Date and Time

ExCEL Contacts and Event Information

Contacts

  • For Clinical Skills Center and Standardized Patient questions, please contact Gina Shannon (gmshann@emory.edu).
  • For Fresh Tissue Lab and Simulation Center questions, please contact Kim Fugate (kfugate@emory.edu).
  • For IT/AV questions, please contact Jess Bowling (jbowlin@emory.edu).

Event Information

  • Space is not reserved until you have received a confirmation e-mail from an ExCEL staff member.
  • All pertinent materials (cases in final form, checklists, student schedules, etc.) are due 3 weeks prior to your event. Any changes or cancellations within the 3 weeks will result in fees.
  • Failure to submit your materials in a timely manner may result in your event being cancelled.
  • By submitting this request form, you agree to payment of any fees, including late fees, from the SmartKey account or payment method provided: http://med.emory.edu/excel/resources/request-forms/osce.html
  • By submitting this request form, you agree to abide by all SOM building policies and fees: http://med.emory.edu/excel/resources/building-use.html