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Pat Capps Covey College of Allied Health Professions  
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Physician Assistant Studies
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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?

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

Address 1:  

Address 2:  

City:  

State:  

Zip:  

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

Comments:


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