Student Profile Information | Yale Interdisciplinary Center for Bioethics

First Name (as it appears on your birth certificate or passport) *

Middle Name (as it appears on your birth certificate or passport)

Last Name (as it appears on your birth certificate or passport) *

Preferred First Name

Full Name, exactly as you wish it to be printed on your certificate (upon program completion) *

Preferred pronouns

Email address (for program communications including access to Yale's course portal) *

Undergraduate University Last Attended/Attending *

Graduate School Last Attended/Attending

Current Field of Study (e.g. medicine, law, public health) *

Current Title/Position (e.g. full-time student, research assistant, post-doc, physician, etc) *

Employer's Name (if currently employed)

City & Country of Origin *

Current Address *

How did you hear about the program (please be specific)? *

Phone *

Date of birth *

Day

Month

Year

Permissions & Compliance *

By typing my name in this box: (1) Photo Release - I give Yale University permission to record my image and / or voice and grant Yale University all rights to use these sound, still, or moving images in any medium for educational, promotional, advertising, or other purposes that support the mission of the university. I agree that all rights to the sound, still, or moving images belong to Yale University. I have read and understood this Agreement and I am over the age of 18. This Agreement expresses the complete understanding of the undersigned and Yale University regarding the subject matter contained herein. I understand that if I do not give permission, I must directly contact bioethics@Yale.edu so that they can put a plan in place to meet this request. (2) I understand I must follow University policy related to all vaccines, including Covid-19 vaccines; (3) I give permission to share my name, affiliation, photo, and email address with fellow students and faculty in the program for networking purposes and class communications. I understand that if I do not wish to give permission, I must directly contact bioethics@Yale.edu so that they can put a plan in place to meet this request.

June Seminar Preferences

The first term, we will offer "core" courses. Do not worry about making your "final" selection now but it would be helpful if you could let us know (a) which of the following seminars ("mini-courses") are you leaning towards taking and (b) how many seminars you would like to take in June (you may select between 2 and 4). Choices are: (1) Clinical Ethics; (2) Ethical Policymaking; (3) Law & Ethics; (4) Animal Ethics through One Health Lens; (5) Drugs, Society and Ethics

July Seminar Preferences

In July, we will offer specialty seminar courses. Please indicate (a) which of the following seminars may be of particular interest to you, and (b) how many seminars you would like to take in July (you may select between 2 and 4). Like the June term, you will have time to change your preferences! We are just trying to get an idea of what you are considering at this point. Choices are: (1) Neuroethics; (2) Ethics of Emergency Medicine; (3) Public Health Ethics; (4) Ethical Aspects of Wartime Medicine; (5) Ethical & Cross-Cultural Issues in Obstetrics & Pediatrics; (6) Ethics of Psychiatry; (7) Medical Humanities; (8) Global Health, Human Rights & Ethics; (9) Philosophy of Ethics & Technology