MSU Standardized Patient Application
Would you like to help the Doctors of tomorrow improve their skills?  Fill out this brief application to become a Standardized Patient with Michigan State University's College of Human Medicine's Simulation Center.
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Email *
First Name *
Last Name *
Email Address *
Is this your own individual email? *
Street Address *
City *
State *
Zipcode *
Are you willing to travel to the East Lansing College of Human Medicine location? *
Home Phone *
Cell Phone
Emergency Contact & Phone
Date of Birth *
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Age *
Identified Gender *
What is your cultural background and/or race *
Do you speak any language other than English? If so, what language? *
Do you know any current or upcoming CHM students? If so, who? *
Have you ever been convicted of a misdemeanor or felony crime? If so, when and please describe. *
(The University will conduct a criminal background check on all prospective employees. A "yes" response will not automatically disqualify an applicant from employment consideration. Each applicant will be evaluated based on the nature of the crime, severity of offense, when it occurred, and the duties and responsibilities of the position for which an individual is being considered.)
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