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Health (physician, nurse, community healthcare worker,etc.)
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BASIC INFORMATION
First name
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Last name
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Email address
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Gender
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Which organization/university/institution are you affiliated with?
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Current position
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Expertise
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What expertise do you have that can be applied to healthcare? Think about what you can bring to your team.
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How did you learn about this event?
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AVAILABILITY
The event will take place on the weekend of December 13-14, 2014. To enable the most progress, we want you to participate fully throughout each day. Are you committed to attending both the days?
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If you answered 'no' to the above question, please explain why you can't attend all 2 days in the space below.
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INTEREST & MOTIVATION
What healthcare problem in relation to the Ebola crisis would you like to solve?
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What broad category does the problem represent?
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TEAM & BEYOND
What expertise would you be looking for within your team?
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Do you already have a team that you intend to work with? Please explain.
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If things work out, would you be interested in working on your project after the hack-a-thon? e.g. enter it into grant competitions or form a startup?
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QUESTIONS OR FEEDBACK