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Action Learning Elective Request
Please fill out this form if you are looking to apply an Action Learning Lab project (other than Healthcare Lab) towards your Healthcare Certificate. If you have any questions, contact us at
healthsystems@mit.edu
.
* Indicates required question
First Name
*
Your answer
Last Name
*
Your answer
MIT ID Number
*
Your answer
MIT Email Only
*
Your answer
Action Learning Lab Course Number
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Your answer
Action Learning Lab Name
*
Your answer
Number of Units
Your answer
Project Title
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Your answer
Project Host
*
Your answer
Describe your project.
*
Your answer
How does your project directly or indirectly relate to healthcare issues?
Your answer
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