Project Zygote Application Form
Application form for participation in the Fall 2017 Cohort
What is your name? *
Your answer
What is your email? *
Your answer
What is your phone number?
Your answer
How did you hear about Project Zygote? (If a specific person referred you, please input their name to possibly qualify for a discount.)
Your answer
What is the link to your LinkedIn Profile?
Your answer
Please select all that applies to your background:
Which types of organizations have you worked for? Please select all that apply.
Please select how you would like to participate in Project Zygote. (If none of these apply to you, or if you have questions, please send us an email.) *
The Fall 2017 workshop dates are as follows.
Kickoff Intro Event: Thursday, September 28, 2017
Workshop 1: Saturday, October 7, 2017
Workshop 2: Saturday, October 21, 2017
Workshop 3: Saturday, November 4, 2017
Workshop 4: Saturday, November 18, 2017
Workshop 5: Saturday, December 2, 2017
Showcase Event at Health 2.0 SF Chapter Meeting: Tuesday, December 12, 2017
How many sessions will you be able to attend? (We know that schedules over several months can be hard to predict but please answer as accurately as possible so we can create the best experience for everyone involved.)
Please select the following that applies to your participation in Project Zygote.
Please tell us in a few sentences: (1) your story / your interests in digital health (2) your background (3) what you're great at.
Your answer
Why would you like to be a part of Project Zygote and what are you hoping to get out of the program?
Your answer
Please tell us one fun fact about yourself!
Your answer
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