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Pat Capps Covey College of Allied Health Professions
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Dear Graduates,

Please take our alumni survey to help us collect information valuable for grants, awards and scholarships.  http://ccwebsrv.usouthal.edu/classclimate/indexstud.php?typ=html&user_tan=UGR8M   
Thank you for your help!

What Our Graduates Are Doing?

(As it appeared when you attended USA and, if married, married name)

Address 1:  

Address 2:  




Phone 1 (ex:251-555-5555):  

Phone 2 (ex:251-555-5555):  

Email Address: (required)  

Preferred Method of Contact:    Email    Phone

Year of Graduation:  

Current Employer:  

I am employed in:

Is your Practice in a Designated Medically Underserved Area (MUA)
or a Health Professions Shortage Area (HPSA)?    Yes    No   Not Sure
Designation type if known:  
To find out, please visit http://bhpr.hrsa.gov/shortage/

Is your main clinical practice in primary care?
(e.g Family Medicine, General Internal Medicine, Pediatrics)     Yes    No

My current clinical practice is in: (choose as many as apply)  

 Allergy  Ob/Gyn
 Anesthesiology  Pathology
 Correctional Medicine  Pediatrics General
 Dermatology  Pediatric Subspecialty
 Emergency Medicine/Urgent Care  Physical/Rehab Med
 Family/General Practice  Psychiatry/Behavioral Medicine
 Geriatrics  Public Health/Preventive Medicine
 Industrial/Occupational Medicine  Radiology
 General Internal Medicine  General Surgery
 Medicine Subspecialty  Surgery Subspecialty
Please provide subspecialty or other as needed:

Are You Precepting Students?    Yes    No

Would You Be Interested In Precepting Students?    Yes    No

Would You Be Interested In Lecturing To Our Didactic Class?    Yes    No

Would You Like To Be Added To Our Newsletter Mailing List?    Yes    No


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