App-a-Thon forHealth Application Form

I. Personal Information

Gender * —Please choose an option—MaleFemale Nationality * —Please choose an option—AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCentral African RepublicChadChileChinaColombiaComorosCongoCosta RicaCroatiaCubaCyprusCzech RepublicDemocratic Republic of the CongoDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFijiFinlandFranceGabonGambiaGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandItalyCôte d'IvoireJamaicaJapanJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorth KoreaMacedoniaNorwayOmanPakistanPalauPalestine StatePanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth KoreaSpainSri LankaSudanSurinameSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamYemenZambiaZimbabwe

II. Educational/Professional Background

Current Role/Position * —Please choose an option—StudentProfessionalResearcherEntrepreneurOther (Please Specify Below)

III. Team Members

Hackathon Topic * —Please choose an option—Accelerating Drug Discovery with AIAdvancing Diagnostics and Personalized Medicine through AIData Privacy and Security in Digital HealthBuilding a Thriving Healthtech Startup EcosystemUniversal Health CoverageLeveraging Big Data, Cloud Computing, and Advanced InfrastructuresInclusion and Accessibility in HealthcareDigital Health in Sports MedicineRevolutionizing Emergency Medicine with Digital HealthOther (Please specify)

IV. Mentorship and Support

Do You Require Mentorship and Support? * —Please choose an option—YesNo Availability for Bootcamps and Training Sessions * —Please choose an option—YesNo

V. Gender and Diversity

Does your team include members from diverse backgrounds? * —Please choose an option—YesNo

VI. Additional Information