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Independence/Jefferson Health Hack Mentor Application
Please submit the following form if you are interested in being a mentor and/or Judge at the IBC/Jefferson Health Hack happening Nov 4-5, 2016. It is not required that you are available for the entire weekend but please feel free to fill out as much availability as you like!
We invite all mentors to join us for the opening reception and problem pitches on Friday evening. Mentors are need for 3 mentor blocks are Saturday. Practice pitch advisors and judges will be needed for Sunday.
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Full Name
*
First and Last please
Your answer
Email address
*
Email will be our primary form of communication so no junk mail accounts please!
Your answer
Were you referred by anyone to join our mentor team?
If so, please let us know who sent you!
Your answer
Are you interested in being a mentor?
Please select all the time slots you are available to mentor.
Saturday 9am-Noon
Saturday Noon-3pm
Saturday 3pm-6pm
Saturday 6pm-9pm
Other:
With which of the following categories do you identify most?
We know that you may be awesome in several (or all) of these categories. We just want an idea of what you consider to be your primary expertise.
I'm involved in healthcare (as a healthcare professional, administrator, or student)
I'm a designer (or design student)
I'm an entrepreneur (or business student)
I'm an engineer
I'm a coder/developer
Clear selection
What is your background (personal, educational, professional, etc.)?
Response Limit: 150 Words
Your answer
What skills or experience are you excited to share with hackathon participants?
Response Limit: 150 Words
Your answer
What interests you about being a mentor at the Hackathon?
Pure curiosity is a perfectly good answer! Response Limit: 50 Words
Your answer
Which track at the Health Hack interests you most?
Augmented/Virtual Reality
Connected Health
Patient Engagement
Clear selection
Are you interested in being a judge?
To maintain objectivity, judges cannot act as mentors. Judges must be available from 1pm-5pm on Sunday.
Yes I would like to be a judge on Sunday
Are you interested in advising practice pitches?
Practice pitch advisors must be available Sunday morning from 9am-Noon
Yes I can advise pitches on Sunday morning
Are you interested in running a breakout session on Saturday afternoon?
Please choose from our anticipated sessions below or suggest your own
Making a wireframe mockup of an app
How to make a business plan
Pivot Point - for teams that are stuck
Other:
Do you have an allergies or dietary restrictions?
Please let us know.
Your answer
What is your t-shirt size?
Small
Medium
Large
Extra Large
XXL
Other:
Clear selection
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