Name * Required First Middle Last Email * Required Select a role * RequiredMedical StudentFacultyStaffProposed Item * RequiredBrief Description * RequiredAnticipated educational impact/rationaleCourse(s) impacted (if any)If you are a student, consider partnering with a faculty member from the course or coursesNumber of students per year impacted (estimated) * RequiredType of CostsEstimated total cost to implementSupporting equipment/technology start-up costOngoing equipment, maintenance, training, other costsCost sharing available?YesNoRecurring or one-time cost? * RequiredRecurringOne-timePlease describe the costs.Recurring purchase of supplies to support the item?YesNoKey Personnel * RequiredName and email per line.Additional Information
