Critical Care e-Learning Program
Durham College
Simulation Request Form
Please note this form is ONLY for application to the Durham College Simulation Lab.
If you plan on registering at a partner simulation lab:

To register at an alternative simulation lab you will need to contact the
appropriate person listed below for dates since dates may vary from the
Durham College posted simulation dates (for additional labs not listed please
contact the program coordinator at Sandra.goldsworthy@dc-uoit.ca).

Please note there is an additional fee of approximately $800 to register at a
simulation lab outside of Durham College.

Confederation College, Thunder Bay contact Lynne Thibeault
lynne.thibeault@confederationc.on.ca

Sault College, Sault Ste. Marie contact Janet Piper
janet.piper@saultcollege.ca

Fanshawe College, London contact Carol Butler cbutler@fanshawec.ca

Queen’s University, Kingston contact Marian Luctkar-Flude mfl1@queensu.ca

University of Windsor, Windsor contact Judy Bornais jbornais@uwindsor.ca
Durham College Simulation Application

In order to apply for simulation you must have successfully completed all online
courses.

If you started your course in September, the deadline to apply for simulation is
May 15th.

If you started your course in January, the deadline to apply for simulation is
August 15th.

If you started your course in May, the deadline to apply for simulation is
December 15th.

Completed forms must be sent to carol.connor@durhamcollege.ca. You
will receive confirmation of your enrolment. If you do not receive
confirmation please contact Carol Connor.
Name: __________________________________________________________
Address:_________________________________________________________
________________________________________________________
Telephone number: _______________________________________________
Email:___________________________________________________________
Date started in program:________________________________________
Date of simulation course:__________________________________________
 I have successfully completed all six eLearning courses