PPD 515 - Spring 2022 D-Clearance Request

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Fill out the entire form below. PLEASE NOTE: All fields are required.
After completing this form, please click the "Submit" button found at the bottom of the page.

Your information will be emailed to the MHA Program Administrator, Jennifer Kim, who is responsible for the d-clearances assigned to this course.

STUDENTS, PLEASE DO NOT REQUEST D-CLEARANCE FOR MULTIPLE SECTIONS. THIS WILL DELAY PROCESSING OF YOUR D-CLEARANCE.

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First Name *

Last Name *

USC ID Number *

Example: 1111222233 (no spaces or dashes)

USC email address *

Example: tommytrojan@usc.edu

Phone Number *

Example: 555-555-5555

Program of Study *

Master of Health Administration

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