Request Form

ExCEL Request Form For:

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

*indicates a required field

Please note:

- Javascript must be enabled on your web browser.

- 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


  • For Clinical Skills Center and Standardized Patient questions, please contact Gina Shannon (
  • For Fresh Tissue Lab and Simulation Center questions, please contact Kim Fugate (
  • For IT/AV questions, please contact Jess Bowling (

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:
  • By submitting this request form, you agree to abide by all SOM building policies and fees: