Join MAYA

Student Interest & Registration Form

Thank you for your interest in MAYA Digital Health Academy.

This form helps us understand your background, current situation and access to learning resources. Please provide accurate information. Submitting this form does not guarantee acceptance into a MAYA program.

Personal Information

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Education & Healthcare Background

Which best describes you? (required)

Current Educational Situation

Are you currently able to attend your regular educational program? (required)

Up to 600 characters.

Access & Technology

Do you currently have access to the internet for learning? (required)
What device(s) do you have access to for learning? (required)

Select all that apply.

Would you be able to participate in online learning activities when required? (required)

Up to 600 characters.

About You

Up to 1000 characters.

Up to 800 characters.

Up to 800 characters.

Availability & Commitment

How much time could you realistically dedicate to MAYA each week? (required)
Would you be able to participate regularly and complete assigned learning activities? (required)

Final Confirmation

Please do not include sensitive personal information that is not requested in this form.