Understanding and Transforming the Medical Industrial Complex Fall 2019 Enrollment Form
We are excited you're enrolling in the Health Justice Commons' online course, Understanding and Transforming the Medical Industrial Complex (MIC)! Welcome to our community. Help us learn about you and your learning goals so we can tailor the course to your needs and interests.
I am am a/ an
Nurse, Nurse Practitioner, Physician, Physician's Assistant
Healer, Curandera/x, Energy Worker, Acupuncturist, Herbalist, Midwife, Ayurvedic Doctor
Therapist, Social Worker, Psychologist, Psychiatrist, Mental Health Worker/ Practitioner
I am most interested in applying content from this course to
My work: clients, patients, communities
My activism and organizing
My academic research and study
My personal healing
My primary goals for taking this course are to
Increase my knowledge and competency of the MIC and healing justice
Increase my knowledge and understanding of critiques of science and peoples' science approaches
Increase my knowledge and understanding of the history of the MIC and medical aparteid
Increase my knowledge and understanding of disability justice
Please share why you have chosen to take this course?
Please share one to two questions you'd like the course to address. If you'd like to share more about your learning goals or interests here, please feel free.
Do you have any access needs or requests you'd like to share with us?
To complete your enrollment, please submit payment by following this link:
. This link takes you to the Paypal donations page of our fiscal sponsor, the Social Good Fund. Please type 'Health Justice Commons Fall 2019 Course' in the Memo section. Enrollment fee is sliding scale $150-$275. Partial scholarships and work trades are available. For more info or questions, please email us at:
. Thank you <3!!!
I have submitted payment
I have not yet submitted payment
I intend to contact Mordecai for a scholarship or volunteer opportunities
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. -
Terms of Service