SP Application Form

 

Become a Standardized Patient

Thank you for your interest in becoming a volunteer in our Standardized Patient Program.

Your commitment to the Center for Clinical Skills (CCS) is important to our program. Without your participation, we would not be able to offer this effective and innovative program to students. We sincerely appreciate your time and efforts. We are confident you will find your experience with our program to be rewarding and enjoyable!


Please complete the application form below. After you complete the application form:

  • We will review your form.
  • We will contact you prior to an event. Standardized Patients (SP) are chosen based upon case requirement. Your patience is appreciated as we work to find the right case for you!

SP Application Form

  • Please fill in your height
  • Please fill in your weight
  • Okay to contact you at work? If so, please provide your work number, and extension, if applicable.
  • Please select all that apply
  • Please fill in your occupation
  • Please fill in your workplace
    Please notify us if you do become employed by UH. It is important that we know this before we recruit you for an event.
    Please notify us if you do become employed by the state. It is important that we know this before we recruit you for an event.
  • Please select all that apply
  • Please list out all your ethnicities in the box