Please complete all questions. The deadline to submit this application is Friday, May 21, 2021 by 11:59pm.

A letter of recommendation (from and educational authority--faculty, instructor, dean, etc.) is also required for this scholarship. This letter can be submitted to Jason Murillo at jmurillo@usc.edu.

The deadline to submit the letter to Jason Murillo is Sunday, May 23, 2021.

Please email your CV to Jason Murillo no later than Sunday, May 23, 2021.  The CV does not need to be uploaded to MedOasis.

Question Title

* 1. Last Name

Question Title

* 2. First Name

Question Title

* 3. Student ID Number

Question Title

* 4. Email

Question Title

* 5. Current Class Year (MSI, MSII, etc.)

Question Title

* 6. Are you a US Citizen or Legal Resident?

Question Title

* 7. Please list any scholarships you have received this year from the Keck School of Medicine of USC

Question Title

* 8. Please list and describe your academic honors/awards (Dean's Recognition, Weeks of Honors, High Pass, AOA, etc):

Question Title

* 9. Describe your medical interest ( specialty interest; research interest; etc., 7 to 10 sentences).

Question Title

* 10. Autobiography/Essay. Write a brief (about a page) autobiography/essay. Include the following information: birthplace and date of birth; undergraduate institution and major; number of college graduates in your immediate family; parent information (names, occupations, if physicians include their specialty, parental income).  Also, discuss why you are interested in pursuing a career in primary care.  Are there experiences that have influenced this career path?

T