Vision

The vision of the Society for Simulation in Healthcare Academy (SSHA) is a world in
which simulation is integral to ensuring high quality, safe healthcare.

Mission

The mission of the Society for Simulation in Healthcare Academy (SSHA) is to recognize
and convene a diverse community of SSH thought leaders who harness their collective
wisdom and expertise to advocate for excellence in simulation through: nurturing leaders;
cultivating the global simulation community; promoting innovation in education,
research, and safety in healthcare.

SSH Academy Applicant Reference Form

Name (person completing/submitting this form):

Applicant Name:

Job title in healthcare simulation:

What is your job setting in
healthcare simulation?

Which of the following apply to your
relationship with the applicant?
(select all that apply)

How long have you known this applicant?

A Confict of Interest (COI) shall be considered to exist if:
The individual completing the reference gains "personal, professional, or financial benefit" by completing the reference

By checking this box, I am confirming that I
have no known Conflict of Interest (either
real or perceived) with this applicant:

Please answer all of the required questions below (as well as the optional last question as desired).
Your input and insights are very valuable to the reviewers, so please be factual, accurate, and complete in your statements.

The information you share is confidential and will not be shared by SSH or any of the reviewers with the applicant.

***BE EXPLICIT ABOUT THE SUSTAINED IMPACT AND CONTRIBUTIONS OF THE APPLICANT AS POSSIBLE

Please provide a brief description of
your relationship to the applicant and,
if applicable, the applicant’s role in your
organization(s).

Please provide specific examples and/or
insight into the sustainable and impactful
contributions the applicant has made to
the Society for Simulation in Healthcare.

Please provide specific examples and/or
insight into the sustainable and impactful
contributions the applicant has made to
the field of simulation.

Please describe how you feel this person
would contribute to the mission
and vision of the SSH Academy?

Is there anything else we should
know about the applicant?

I confirm that the information provided
above is factual and accurate.