The information that you provide in this form is used by Menzies Foundation and MedTech Actuator to assess your application. This information, including personal information, will be disclosed to the Application Review Board made up of Menzies Foundation and MedTech Actuator members, and non-confidential information may be made public through Menzies Foundation and MedTech Actuator social media and websites.
I, certify that:
• The statements in this application are true to the best of my knowledge and any supporting material is my own work.
• I accept that Menzies Foundation and MedTech Actuator reserves the right to use whatever assessment processes and selection criteria they deem necessary to evaluate this application for the Fellowship Program.
• If my application is successful, I consent to my ‘Project sentence’ and ‘Non-confidential summary’ to be used by Menzies Foundation and MedTech Actuator for announcements via their respective social media platforms and websites.
• I am committed to participating fully in the program sessions and agree to be available on the following dates:
November 11, 2021 - MedTech Actuator Menzies Fellowship Selection Interviews
July-December 2022 - MedTech Actuator Accelerator (1st week of every month)
December, 2022 - Wrap up of the Fellowship
By signing (typing your legal name) in the space below, you are certifying that all information is correct and that you are the person completing this application. When you press the submit button, you will receive an email confirmation that your application was received. Please print for your records and retain as verification of your application.