2021 Summer Out of Area Request and Consent form
Fill out this form ONCE. You will be directed to the site specific form after you complete this one.
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Full name (e.g. Tommy Trojan) *
USC email address *
Cohort *
Anticipated graduation year *
Rank practice areas by preference
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Adult Rehabilitation
Pediatrics
Mental Health
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This request sets a process in motion that may include outreach to existing and/or new fieldwork sites, and the potential negotiation of a student affiliation agreement.  The USC OT Fieldwork Team cannot guarantee that this request will be granted, however every effort possible will be made to secure a placement. It is the student’s responsibility to identify potential fieldwork sites in the desired location(s) and practice area(s). By clicking “I agree” below, I am agreeing to accept the fieldwork placement that the USC OT Fieldwork Team arranges for me. If I decline a placement that is confirmed for me, I understand that my new request will be considered only after all students receive an initial placement. *
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