Hacking Dermatology Participant Application
If you are interested in being considered to be a participant at the Virtual Hacking Dermatology event please complete this application. Applications will be considered on a rolling basis and you will be notified within 2 weeks of your application being submitted.

Dates: October 23-25, 2020
Location: Virtual

- Participants will join teams of 5-6 at the beginning of the event
- Collaboration will be facilitated via tools such as Zoom, Slack and Google Drive.

If you are interested in being a mentor, who shares expertise and guidance with multiple teams, please fill out the mentor application (https://forms.gle/xYEpTMKf1gNdpmuF7).
Email address *
First Name *
Last Name *
Please list your preferred credentials:
What is your age range? *
Please tell us where you are located (city, state, and country). *
Which of the following best describes you? *
What is your school/company affiliation? *
What is your current title? *
What best describes your Primary background? *
What are your additional background areas?
Can you commit to attending virtually all three days on October 23-25, 2020? *
What is your experience in innovation / hackathons / healthcare / dermatology (if any) and what are some relevant skill sets/prior experience? *
Do you have any preliminary ideas you’d like to work on during the hackathon? This is NOT a prerequisite. * *
Please tell us the title of your idea/project, the general idea, goals, and data sets/resources needed to work on project.
How did you hear about this event? *
Required
Comments / Questions / Concerns?
When you attend the hackathon and/other other related events, you will enter an area where photography, audio, and video recording may be taken and where members of the media may be present to cover the event. By attending this event, you consent to photography, audio, and video recording and its release, publication or reproduction to be used in the future. Do you acknowledge this? *
A copy of your responses will be emailed to the address you provided.
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