Skip to content

Pilot Program Participation

Enrollment Application

The Janie Appleseed Network pilot program will engage families in the use and development of an emerging class of health information technology systems aimed at giving consumers sovereignty over their personal health data. A personal health record system, or PHR, is a digital computer application that helps a consumer store and manage personal health data captured over time. A PHR helps a person collect and use past information to inform present and future health and care choices. A subscription service for the PHR technology, called MyPHD Wellness Manager, will be provided to participating families at no charge during the pilot. The pilot program begins January 1, 2018 and runs for a full year.

Applications are being accepted in October and November, 2017. Selected participants will be notified in December, 2017.

If you are interested in having your family participate in the pilot program, please complete this survey.
1.What is your age?
2.What is the highest level of school you have completed or the highest degree you have received?
3.Which of the following categories best describes your employment status?
4.Are you White, Black or African-American, American Indian or Alaskan Native, Asian, Native Hawaiian or other Pacific islander, or some other race?
5.How much total combined money did all members of your HOUSEHOLD earn last year?
6.What is your gender?
7.Are you Mexican, Mexican-American, Chicano, Puerto Rican, Cuban, Cuban-American, or some other Spanish, Hispanic, or Latino group?
8.Select the program category where your family would fit best:
9.How many family members are you likely to include in the pilot program?
10.How would you rate your current computer skills?
0 Current skills are minimal
5 Average
10 Very proficient
11.Would you be willing to attend product training in an on-line or face-to-face session?
12.Would you be willing to provide product feedback?
13.Would you be willing to have a Janie Appleseed Network representative contact you to discuss the pilot program?
14.What is your first name?
15.What is your last name?
16.At what email address would you like to be contacted?
17.What is the best phone number to use to contact you?
Current Progress,
0 of 17 answered