LCCME Student Application by S1av5moR

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									  LONGIDUTINAL CLINICAL COMMUNITY MEDICINE EXPERIENCE
                                      (KECK-USC LCCME)


2011-2012 LCCME APPLICATION
***Application deadline is July 13, 2011.
Please send application to Yvonne Banzali at Banzali@usc.edu or send to KECK-USC Primary Care
Community Medicine Program1975 Zonal Ave. KAM B-33 Los Angeles, CA 90089 ***

DATE:

NAME:

EMAIL:

HOME PHONE:                                             CELL PHONE:

ADDRESS:


UNDERGRAD GRADUATION YEAR:                              MAJOR:

What languages do you speak? Please list all.


Do you have any post undergraduate work/studies/work abroad/ leadership experience/community
involvement? Please list all:




REQUIRED ESSAY:
There is a required essay for this application (3 pages max.). Please attach this application form to your
essay and send it to the program coordinator by the application due date. Thank you.

Please address the following questions in your essay (3 pages max).
    1. Why are you interested in this program?
    2. What is your understanding of primary care?
    3. What experiences/interests do you have that draw you towards primary care and community
        work as a future career choice? How do you see this experience supporting those interests?



***Applicants will be notified via email by August 1, 2011.***

								
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