Graduate Certificate in Health Informatics (GCHI) - Declaration of Intent Form
Thank you for your interest in the Graduate Certificate in Health Informatics (GCHI).

Please complete the questions below to declare your intent to pursue the Certificate.

Once we receive this form, we’ll update your official transcript to show matriculation into the certificate and we’ll add you to the certificate e-mail list.

For general inquiries email hi.certificate@umich.edu or visit https://www.si.umich.edu/programs/non-degree-offerings/graduate-certificates/graduate-certificate-health-informatics.

Email *
It is important to meet with your advisor about any double-counting requirements your current graduate program may have (if any). Have you discussed your academic plan for completing both your graduate degree and the GCHI certificate prior to declaring intent to enroll in the GCHI?
Clear selection
First Name *
Last Name *
Your 8-digit umid number: *
Your umich e-mail address: *
What department or program are you currently enrolled in? *
What degree are you currently working toward?
What is your expected graduation term? *
I understand that I am not guaranteed enrollment in GCHI courses *
Required
How did you hear about the Certificate in Health Informatics?
Clear selection
If you selected 'School Orientation' or E-mail Communication', please indicate the school or individual below:
Thank you for your interest in the Certificate in Health Informatics!
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of University of Michigan.

Does this form look suspicious? Report

Google Forms