Shadow Health - Training Request Form

Shadow Health - Training Request Form
Congratulations on selecting our innovative and dynamic learning environment for your students! The Shadow Health Digital Clinical Experience (DCE) transforms nursing education by increasing student engagement, offering opportunities for reflection, developing clinical reasoning skills, and provide clear records of student performance. To help us customize training to fit your needs, please fill out the following information.
Institution Name
*Enter the course(s) that will be using the DCE throughout the year*
Course Name and Course Number # of Students Start Date
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Payment Type
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1st Sem. Use
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*For each upcoming course(s) using the DCE, please enter the instructor(s) name, and email.*
Course(s) Instructor Name Instructor Email
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Select a Training Medium*
If Skype is Selected, Please Enter Skype User Name
Select a Possible Training Date and Time (Option #1)*
MonthDayYearHourMinutesAM/PM Option
Your Time Zone*
Select a Possible Training Date and Time (Option #2)*
MonthDayYearHourMinutesAM/PM Option
Time Zone
Course Syllabus (Draft Syllabus is Acceptable)
Upload a File
Cancelof
Should be Empty:

	Course Name and Course Number	# of Students	Start Date
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