Hacking Dermatology Application
Hackathon Dates: June 8 - 10, 2018. $80k in grants will be awarded to winning teams!

All demographic information is collected for purposes of making this and future programs inclusive and diverse.

Email address *
First name *
Your answer
Last name *
Your answer
What is your email address? *
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What is your phone number? *
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What is your gender? *
What is your age range? *
What city will you be coming from? *
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What state will you be coming from? *
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What is your occupation? *
What is your school/company affiliation? *
Your answer
What is your current title? *
Your answer
What best describes your background? Examples: Physician/Dermatology, Scientist/Data Scientist, or Designer/Industrial Design *
Your answer
Can you commit to attending all three days on June 8 - 10, 2018? *
If "No", please describe which days/times of the hackathon you will miss. If "Yes", write n/a. *
Your answer
What is your experience in innovation / hackathons / healthcare / dermatology (if any) and what are some relevant skill sets/prior experience? *
Your answer
We will have 5 main subdivisions of problems to hack. Select all areas that you are interested in. *This is not binding. *
Required
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.
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How did you hear about this event? *
Do you have any dietary restrictions?
Your answer
Comments / Questions / Concerns?
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Are you interested in being added to Hacking Medicine Institute's mailing list? *
When you attend the hackathon and/other other related events, you will enter an area where photography, audio, and video recording may be taken. 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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