Mastery Learning Course Application

This is the application portal for Designing and Implementing Simulation-Based Mastery Learning Curricula course.

For more information on the program or application process, click here: Learn More About Mastery Learning

Full Name Full Name First Last
Name (as it should appear on your nametag) Name (as it should appear on your nametag) First Last
Academic Title
Email
Phone Phone - ### - ### ####
Hospital or Academic Affiliation
Department
Specialty
Degree(s)
Enter Your Name As It Should Appear On Your Certificate of Completion (include degree(s), if appropriate)
Mailing Address Mailing Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
CV and Headshot Upload
Please upload a copy of your CV.

Attach Files
Upload a recent headshot

Attach Files
Curriculum Title and Document Upload
What is the title of your curriculum?
Please upload a two-page description of a curriculum that will serve as a foundation for your coursework.

Attach Files
Tentative schedule is 7:30 AM - 5:30 PM
This schedule is subject to change; please check website or contact simed@northwestern.edu for more information.

Tentative schedule is 7:30 AM - 5:30 PM
This schedule is subject to change; please check website or contact simed@northwestern.edu for more information. Registration: September 24-26, 2026 | External Rate Registration: September 24-26, 2026 | Early Bird Rate* Registration: September 24-26, 2026 | Military / Government Registration: September 24-26, 2026 | Northwestern Affiliate Registration: September 24-26, 2026 | FSM Faculty (with teaching duties) Registration: September 24-26, 2026 | MSHPE Student

*The Early Bird Rate expires at 11:59PM on Sunday, May 31, 2026. To receive the discount, payment must be received by May 31st.
Dietary Restrictions (if none, enter NONE)
How did you hear about the Mastery Learning course?

How did you hear about the Mastery Learning course? Word of Mouth Email LinkedIn X (formerly Twitter) Electronic Direct Mail (email) Instagram Northwestern Simulation Website SSH Newsletter Healthy Sim IMSH Conference Bedside Medicine Conference MSHPE Student Other Other

Mastery Learning Course Application

Mastery Learning Course Application

CV and Headshot Upload

Curriculum Title and Document Upload