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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Credit Card
Invoice
Unknown
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Credit Card
Invoice
Unknown
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Credit Card
Invoice
Unknown
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Credit Card
Invoice
Unknown
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Credit Card
Invoice
Unknown
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Credit Card
Invoice
Unknown
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1st Sem. Use
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Yes
No
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Yes
No
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Yes
No
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Yes
No
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Yes
No
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Yes
No
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*
Program Type
*
Undergraduate
Graduate
RN to BSN
A.D.N.
P.A. School
Pharmacy
*
Undergraduate
Graduate
RN to BSN
A.D.N.
P.A. School
Pharmacy
*
Undergraduate
Graduate
RN to BSN
A.D.N.
P.A. School
Pharmacy
*
Undergraduate
Graduate
RN to BSN
A.D.N.
P.A. School
Pharmacy
*
Undergraduate
Graduate
RN to BSN
A.D.N.
P.A. School
Pharmacy
*
Undergraduate
Graduate
RN to BSN
A.D.N.
P.A. School
Pharmacy
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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
*
Please Select
Go To Meeting
Skype
If Skype is Selected, Please Enter Skype User Name
Select a Possible Training Date and Time (Option #1)
*
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Month
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Day
Year
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:
Hour
00
30
Minutes
AM
PM
AM/PM Option
Your Time Zone
*
Please Select
EST
CST
MST
PST
AKDT
HST
Select a Possible Training Date and Time (Option #2)
*
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Month
-
Day
Year
Date Picker Icon
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:
Hour
00
30
Minutes
AM
PM
AM/PM Option
Time Zone
Please Select
EST
CST
MST
PST
AKDT
HST
Course Syllabus (Draft Syllabus is Acceptable)
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