JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Uniformed Services University of the Health Sciences - Interest / Check-In Form
Thank you for your for visiting our Booth/Session! Please fill out this check-in form so that we may reach back out to you.
Please visit our websites for more information on the programs our school provides below.
USUHS Website
USUHS School of Medicine Website
Enlisted to Medical Degree Preparatory Program (EMDP2) Website
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Name of event attended / How did you hear about us.
*
Website
Other:
Required
What program are you interested in? (check all that apply)
*
USU School of Medicine (SOM)
USU Enlisted to Medical Degree Preparatory Program (EMDP2)
Center for Health Profession Education (CHPE)
Pathways Program (Undergraduate/Post-Gradudate)
I am a physician who would like to be a volunteer/mentor/USU Military Medicine Ambassador (MMA)
Other:
Required
What year do you plan to apply?
*
Class of 2025 (applying summer of 2024)
Class of 2026 (applying summer of 2025)
Class of 2027 (applying summer of 2026)
N/A
Other:
Required
First Name
*
Your answer
Last Name
*
Your answer
Contact Email Address
*
Your answer
Hometown (City, State)
Your answer
Current School/University and location (ie. George Mason University, Fairfax VA) Please do not use acronyms.
Your answer
Current Branch of Service (ie. civilian, USAF, Army etc.)
*
Civilian
Air Force
Army
Navy
Marine Corps
Coast Guard
Space Force
Public Health Service
Other:
Current Rank (ie. civilian, SSGT, etc.)
*
Your answer
Current Grade (ie. civilian, E-5, O-2 etc.)
*
Choose
Civilian
E-1
E-2
E-3
E-4
E-5
E-6
E-7
E-8
E-9
O-1
O-2
O-3
O-4
O-5
O-6
O-7
O-8
O-9
O-10
What makes you interested in Uniformed Services University?
Your answer
Additional Questions/Comments
Your answer
Submit
Page 1 of 1
Clear form
Never submit passwords through Google Forms.
This form was created inside of Usuhs.edu.
Report Abuse
Forms
