Standardized Patient Application

** (none of this information is shared with anyone outside this program) **

Please note: Simulation only hires new standardized patients on an as needed basis. We will keep your application on file until a need arises. If you have not been contacted, then it is likely that no openings are currently available. We typically only schedule new standardized patient trainings once a year. Thank you for applying!

Preferred Campus:

Preferred Campus: CHS (Tulsa) Cherokee Nation (Tahlequah) Both
Name: Name: First Middle Last
Date of Birth: Date of Birth: / MM / DD YYYY
Availability: (are there any days of the week that you are routinely NOT available?)
Gender/Preferred Pronouns:
Visible Scars: (surgical and otherwise)
Any limitations to your mobility:
Height:
Weight:
Ethnicity:
Mailing Address Mailing Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code
Email Address:
Phone number: Phone number: - ### - ### ####
Notice:

As a standardized patient you will be required to have initial and routine security background checks ran as part of your vendor agreement with the university.
Do you have any connection or relation to a medical student or graduate student currently enrolled at Oklahoma State University Center for Health Sciences on either campus?

Do you have any connection or relation to a medical student or graduate student currently enrolled at Oklahoma State University Center for Health Sciences on either campus? Yes No If Yes If Yes
If Yes, please note who and how you are connected/related:

Standardized Patient Application

Standardized Patient Application

Notice: