Application Form

Genetic Assistant Training Program

This information is used to track the learners participating in the cohort and ensure the program is reaching those who need it. Only the Office of Online Education and the Department of Genetic Medicine will have access to this information. Your responses will be kept private and secure; this form is anonymous. The information will not be used for a discriminatory purpose. You can change this information in the future by emailing JHOnline@jhmi.edu.

All items marked with an asterisk are required.

Select a Start Term *

Applicant’s Personal Information

First Name *

Middle Name

Last Name *

Birth Date *

Permanent Address

Street *

City *

State *

Postal Code *

Country *

Contact

Email *

Verify Email *

Phone *

Phone Country *

Country of Citizenship

Country *

Work and Education

Employer or Institution

Job Title

Highest Degree Obtained *

If Other: *

Years of work experience related to Genetics or Genetic Counseling? *

Years of education related to Genetics or Genetic Counseling? *

Demographic

What is your race? *

If Other:

What is your ethnicity? *

Would you describe English as your first language? *

What is your gender identity? (select all that apply)
Female Male Non-binary Cisgender Transgender Prefer not to answer Other

Other Gender Identity:

How did you hear about the program? *

If Other: *

Acknowledgement

By clicking Apply, I have reviewed the information disclosed on this application. I authorize Johns Hopkins University School of Medicine to use the above information inaccordance with the Family Education Rights Privacy Act (FERPA) to process my application required for registering and attending the Genetic Assistant Online Program.

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Genetic Assistant Training Program