MHO Open Outreach Registration

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The Harborview Mobile Health Outreach Program is also open to students to volunteer without participation in the Interprofessional Service Learning Leaders Program. If you would like to attend an outreach at a local Tiny House Village, please provide the information below and we will follow up with information about how to sign up.

What is your email? *

Please confirm your email. *

What is your name? *

What is your program/school?

Pharmacy

Dentistry

Public Health (MPH)

Social Work (MSW)

Medicine

Nursing - ABSN/BSN

Nursing - DNP

Physician Assistant

Dietetics

Physical Therapy

Occupational Therapy

Other:

Clear selection

Year 3 *

Year 1

Year 2

Year 3

Year 4

Other:

Please explain why you are interested in this project. *

Do you have access to EPIC through your training program? (EPIC is the electronic medical record system used at UW) *

YES

Other:

Please let us know if you have any additional questions or comments for us.

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