Program Registration

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Thank you for your interest in a Harvard Chan School Executive and Continuing Education program. Please note that we have rebranded to the Harvard Chan Advanced Learning Academy, and as part of this transition, we have new forms for you to register or apply to your program of interest. Please visit our website here, select your program of interest, and then click “Register/Apply Now” at the top of the page to enroll: https://hsph.harvard.edu/advanced-learning-academy/program-finder/

Thank you for your understanding and patience. For any questions, please contact enrollment@hsph.harvard.edu

Discounts

Discount Percent

Discount Type

Discount Amount

Discounted Price

Discount Percent in Dollars

Discount ID

Discount Number of Times Used

Discount Valid?

YesNo

Hidden Fields

Program Code	Program Prefix
Iteration Code	Iteration ID
Registration Started Calculation	Registration Started Payment Deadline
Checkout URL	Registration Status
Waitlist Threshold Delivery Method	Enrolled Attendee Count Standard Price Finance Accounting Code
Attendee Status

Program Name

Program Fee

Will fill in once program dates are selected.

Please select the course dates for which you would like to register:

Who are you registering for this course?

I am registering myself.I am registering someone else.

Company Name

Account ID

Company Account Record Type Id

Your Information

First Name

Please do not use all caps. Max. length 40 characters.

Preferred First Name

Last Name

Please do not use all caps. Max. length 40 characters.

Phone

Your Role/Relationship with the Attendee

Attendee Information

Prefix

First Name

Preferred First Name

Middle Initials

Last Name

Pronouns (optional)

Pronoun Addition

Phone

Gender

Will your employer pay your tuition?

Organization

Name of Payer

Country of origin

Country of residence

Street Address

City

State

Province

Province/Region

County

State

Region

State

Zip/Postal Code

I would like my assistant CC'd on email communications.

YesNo

Assistant's Information

First Name

Preferred First Name

Last Name

Phone

Attendee Current Professional Information

Title

Department

Division

Industry

Management Level

Degrees

Detail your current title, organization, your responsibilities, and the number of years spent in this job. If applicable, please include the number of staff and/or units reporting to you and the value of the budget to which you are responsible.

Please list the title of the person to whom you report.

Please describe why you would like to attend this program and what you hope to get out of it.

What is your position and role at your organization, and what are your responsibilities?

How would this educational experience support or enhance your position, role, and responsibilities?

How do you plan to apply the program knowledge?

Where have you already sought financial assistance, for how much, and what was the outcome?

How much financial assistance do you require in order to attend the program?

Opportunity Name

Username

Nickname

Alias

Other Questions

Emergency Contact Name

Emergency Contact Email

Emergency Contact Phone

How did you learn about this program?

Please specify:

Max. length 255 characters.

Please enter any dietary restrictions or request for reasonable accommodations during the program, such as (but not limited to): captioning, reserved front row, large print, wheelchair access (due to room configuration, the available row is the back row), or lactation room. These are subject to availability and requests should be made at least two weeks before the program start date.

Please select how you would like to pay:

Pay in fullPay in two installments of 50% each

Discount Code

This field will only work if you are using it in conjunction with a special discount URL provided by Executive and Continuing Education.

FERPA CONSENT TO RELEASE STUDENT INFORMATION

I, the undersigned, hereby authorize President and Fellows of Harvard College (“Harvard University”), or an agent designated by Harvard University, to record, store and disclose audio and video recordings of Program sessions in which I am recorded (which may be subject to The Family Educational Rights and Privacy Act of 1974 and other applicable local privacy laws) to other Program participants for the sole purposes of Harvard’s internal educational use and Program participants’ educational use. I understand that this consent is optional, and that I have the right to revoke this authorization at any time by delivering a written revocation to Harvard University, but that such revocation will not affect any waiver of access to records obtained or received prior to delivery of such revocation. I understand that this consent shall also be understood to cover other applicable local privacy laws.

I have read and accept the terms of this Recording Authorization.

Terms & Conditions

Read the Terms & Conditions here.

I accept the Terms & Conditions.

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