Interest Form for Mobile Clinic at USC

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Interest Form for Mobile Clinic at USC

Thank you for your interest in Mobile Clinic! Signing up for the interest form will put you on our mailing list to receive information regarding our outreach cycles every Fall!

Please feel free to email usc.mobileclinic.la@gmail.com with any questions.

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* Indicates required question

First Name *

Your answer

Last Name *

Your answer

Are you a current USC student, faculty, or alumni? *

Student

Faculty

Alumni

Other

Class Standing in FALL 2023 (We are an undergraduate Registered Student Organization)

First Year

Sophomore

Junior

Senior

Graduate/Masters/PhD

Clear selection

USC Email *

Your answer

Major *

Your answer

Minor (if applicable)

Your answer

Submit

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