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1043 Burnett-Womack
CB# 7529
University of North Carolina
School of Medicine
Chapel Hill, NC 27599

Office: (919) 966-3643
Fax: (919) 962-2027

 
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ICM Tutor Patient Facilitator Request

Please fill out this form to request one or more Patient Facilitators for your ICM class.  You must fill out all items or your request will not be processed.  Your request must be submitted at least one week prior to the session.

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Where would you like the Patient Facilitators to meet your class?
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Put any special requests or additional information here. If you need space scheduled in the Clinical Skills and Patient Simulation Center, please make a detailed request. Please contact Dawn Duncan for more information about scheduling rooms in the CSPSC (deduncan@email.unc.edu).

Please review all items before you hit submit.