Hacking Dermatology Mentor Application

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

If you are interested in being considered to be a mentor at Hacking Dermatology on September 13-15, 2019, 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.

Most mentors will commit to being at the hackathon for a minimum of 3 hours on Saturday, Sept. 14 and/or the morning of Sunday, Sept. 15, and will share expertise and guidance with multiple teams. Mentors are encouraged to attend the kickoff event on Friday, Sept. 13 and the judging round on Sunday, Sept. 15 at noon.

If you wish to be a mentor, but cannot attend the hackathon, there are opportunities to be a virtual hackathon mentor and/or a mentor to winning teams in the post-hackathon incubation period (this last option is available to all mentors, given project/expertise alignment).

If you are interested in being a participant, who joins a team and competes in the hackathon activities, please fill out the participant application (https://forms.gle/W5yRa7RDSzxcRcEH9).

Email *

First Name *

Last Name *

Credentials *

What is your organization/academic institution affiliation? *

What is your area of expertise, as related to dermatology, precision medicine, digital health, and entrepreneurship? *

What do you think you will best offer to teams in terms of guidance and advice? *

Please provide a link to your LinkedIn profile, online bio, or CV. *

We request that all mentors commit to attending the hackathon for a minimum of 3 hours during the times when teams will be working. All mentors are also welcome to join Friday evening for the kickoff event and Sunday at noon for the judging round. Can you commit to (please check all that apply): *

Saturday, Sept. 14, morning (between 9am-12pm)

Saturday, Sept. 14, early afternoon (between 12pm-4pm)

Saturday, Sept. 14, late afternoon (between 4pm-6pm)

Sunday, Sept. 15, morning (between 8am-11am)

I cannot attend the hackathon in person, but I would like to serve as a virtual, on-call mentor on Saturday, Sept. 14

I would like to mentor a winning team during the post-hackathon incubation period, given that my expertise aligns with winning projects

Required

Questions/Comments/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? *

Yes

A copy of your responses will be emailed to the address you provided.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms