Inquire to become a Standardized Patient

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Thank you for your interest in the Standardized Patient Program with the RISE Simulation Center at Robert Morris University. Please complete the following application; all information you provide will be kept confidential. Completed applications are reviewed and kept on file, and suitable candidates are interviewed as project needs emerge.

Today's Date *

YYYY

First Name *

Last Name *

Email address *

Mailing Address (for payment purposes) *

Phone number *

Prefered Pronouns

Ethnicity/Race *

Birthday *

Do you have any experience working as a standardized patient (healthcare actor) *

Yes

Maybe

Do you have experience acting? *

Yes

Maybe

Extra Experience (It's great to share any experience that you feel is relevant to this work) *

General Availability (Most of our simulations take place weekdays, between the hours of 7am and 7pm)

Please describe your general availability. (Example: a day(s) of the week or time(s) of the day you are usually or never available):

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