Patient Care

Mederi Academy® Application

Thank you for your interest in Mederi Academy! The application below is only necessary for your initial entry into the program, prior to enrolling in Course 1. You do not need to re-apply to enroll in any courses after that. Course 1 is Defining Mederi Care – A Medical Concept Review Through the Mederi Care Lens. Cost is $1000. View all courses.

To apply, please fill out the fields below and add (upload) all of the required files. We will be in touch with you within one week of submitting your application. For questions, please contact Lisa Newton, our Education Outreach Coordinator, at academyinfo@mederifoundation.org.

Mederi Academy Program Application

PERSONAL DATA

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Name

First Name *

Middle

Last Name *

Address

Please fill in your address below

Country of Citizenship

Telephone

Email

What type of health care provider are you?

Certification & Licensure
If you have current clinical certification or a license, please provide us with a copy of either your certificate or your state license.

Certification Upload

Upload your certification or state license

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License Number

License number (if applicable) and name of licensing board

REQUIRED ATTACHMENT

Please upload your CV or Resume below.

CV/Resume

Upload your CV or Resume here

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TELL US MORE

Are you interested in future courses and/or a certification in Mederi Care?

I am interested in future courses
I am interested in a certification in Mederi Care
I am in interested in future courses AND a certification in Mederi Care

Please tell us how you heard about the Mederi Academy (check all that apply):

Mederi website
Advertisement in journal
Flyer
Webinar
Other

Please specify

Please specify what publication, webinar or other method that you heard about the Mederi Academy from the boxes you checked above.

Questions?

Please let us know if you have any questions.

© 2022 Mederi Foundation

Charitable Disclosures

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