Education at USC Chan
Request Program Information

Once you’ve completed this form, a member of the Admissions Team and one of our Student Ambassadors will reach out to connect with you and help to answer your questions. Please make sure that you complete the required* fields so that we know which program/s interest you and how we can best contact you. Thank you!

Are you currently an occupational therapist?*

(helps determine degree program eligibility)

Yes No

Your name

First / given name*
Middle name
Last / family name*

Your location

Zip / postal code*
Country* (change if not United States)

Your contact details

Email address*
Primary phone #

How did you hear about us?

Please check any that apply*

	Advisor Which advisor?:
	AOTA
	Continuing education Which course?:
	OTAC
	OTCAS
	OT/OS class
	Recruitment event Which event?:
	Speaker in class
	Summer Occupational Therapy Immersion (SOTI) program
	USC Catalog
	US News & World Report
	Word of mouth Which source?:
	Other Which source?:

Can we keep your details?

We would like to keep a copy of your contact details and occasionally — maybe a couple of times a year — contact you about our programs. We will not share your contact details with anyone else and you can ask us to update/delete them at any time. (You can read our general Privacy Policy here.)

Please confirm whether or not you will permit us to store your contact details for this purpose:

Yes No