Apply to Harvard Macy - Educators Course Step 1 of 7 - Account Information 14% Name(Required) Dr.MissMr.Mrs.Ms.Prof.Rev. Prefix First Last Suffix Email(Required) Mobile Number(Required)Profile PictureAccepted file types: jpg, jpeg, png, Max. file size: 3 MB. Alternative Phone NumberMailing Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country How did you hear about this course?Please select an optionHMI AlumniBrochureColleagueEmail/List ServeGoogle AdLinkedin AdBing AdHMI WebsiteHMI NewsletterHMS Continuing EducationAMEE ConferenceAAMC ConferenceOtherGender(Required)Please select an optionFemaleMaleNon-binary / Unspecified (X)Undisclosed (U)Timezone(Required)Greenwich Mean TimeUniversal Coordinated TimeEuropean Central TimeEastern European Time(Arabic) Egypt Standard TimeEastern African TimeMiddle East TimeNear East TimePakistan Lahore TimeIndia Standard TimeBangladesh Standard TimeVietnam Standard TimeChina Taiwan TimeJapan Standard TimeAustralia Central TimeAustralia Eastern TimeSolomon Standard TimeNew Zealand Standard TimeMidway Islands TimeHawaii Standard TimeAlaska Standard TimePacific Standard TimePhoenix Standard TimeMountain Standard TimeCentral Standard TimeEastern Standard TimeIndiana Eastern Standard TimePuerto Rico and US Virgin Islands TimeCanada Newfoundland TimeArgentina Standard TimeBrazil Eastern TimeCentral African TimeTwitter Handle LinkedIn Profile Link Degree(s)(Required)Specialty/Specialties(Required) Note: Enter your professional specialities - if not applicable, enter NAAcademic Title(Required) Note: Enter your academic title - if not applicable, enter NAProfessional Institution Affiliation(Required) Note: Enter the name of your institution/business/organization - if not applicable, enter NA.Professional School Affiliation(Required) Note: Enter the name of your school - if not applicable, enter NA.Health Care Organization Affiliation(Required) Note: Enter your organization name - if not applicable, enter NA.Professional Organization Affiliations Add RemoveEnter any professional organizations for which you are a member. Select '+' to list additional affiliations. Education and Professional Experience(Required)Scholarly Interest(Required)Personal Background(Required) Project Title(Required)During Harvard Macy Institute programs, our attendees work on projects to improve their own institutions. Please enter a short title for the project you intend to work on during the course. Focus of Project(Required)What is the primary focus of your project? What question, concern, problem, or situation is addressed by your project? Describe the educational problem that your project is addressing and why is it important to your institution and / or health professions education overall.Project Goals:(Required)Note: List 1-3 specific goals for your scholarly project. Brief Project Methods:(Required)Briefly describe the methods that you will use to conduct your project.Number of individuals who will be affected / participate in your project (teachers, learners etc):(Required)Please explain each category included in your project. Project Setting(Required)Describe the specific educational setting (i.e., classroom, clinic, ward), institution / department setting where this project is being conducted (location, university affiliated or private, size and scope etc), as well as the larger system within which your project will occur (integrated 4-year curriculum, community health center service with diverse population ages and needs, etc.).Who are the stakeholders/leaders who can influence its success?(Required)What barriers do you anticipate in completing this project?(Required)What target population do you think will be most impacted by your project implementation?(Required)Other team membersWhat target population will your project implementation effect?(Required) Undergraduate Graduate Continuing Professional Development What is the educational focus of your project?(Required) Teaching and Education Curriculum Design Faculty Development Assessment and Evaluation Educational Technology Optional: Upload Project PDF Drop files here or Select files Accepted file types: pdf, Max. file size: 3 MB, Max. files: 5. 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