This application form has four sections and should take 10 minutes to complete. Make sure you are prepared to provide the information outlined in the application section of the program website. 

Program Requirements

*1.Please specify your healthcare profession and organization(Required.)

Healthcare Profession:

Organization:

Contact Information

*2.What is your contact information?(Required.)

Full Name:

Preferred Name:

Phone Number:

Email:

Address line 1:

Address line 2:

Province/Territory:

Postal Code:

Getting to Know You

*3.Are you applying as a team or an individual?(Required.)

Individual

Team (please specify how many team members are applying by listing their names and emails)

*4.What AI program(s) have you completed?(Required.)

*5.State your overall goal(s) for this program.(Required.)

*6.Describe your background coming into this program by writing about at least one of the following options, based on your goals for entering this program:
a. The project you want to receive guidance on. Please include which stage the project is at (i.e., ideation, development, deployment) and any other relevant details and/or,
b. The AI ideas, topics, and experiences you are interested in and would like to explore more.(Required.)

7.What are your objectives for connecting with experts? What guidance or opportunities are you hoping to gain?

8.We will need to balance experts’ time and consider the best-fit for matching Innovators to Experts. If you have any preferences for experts you would like to be matched to, please indicate them below. We will do our best to try to accommodate any preferences however, we cannot guarantee you will be matched with any of your preferred experts.