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Mobile Clinic Title Slide
Two students smiling with child
Group of students and nurses
Doctor with a child patient
Patient getting measured
Student measuring patient
Students using stethoscope
Group of students and patients at mobile clinic
Patient smiling
Patient doing vision test
Student pointing at vision test
Nurse checking pulse of patient
Three volunteers smiling
Mobile Clinic End Slide

USF in DC Program

Application Form

Please complete this form and submit by CLICKING ON THE SUBMIT BUTTON at the bottom of the page.
Application Deadline: March 8th for Fall 2015 or Spring 2016 semesters

How did you hear about this program?


Semester applying for:
Today's date (mm/dd/yy):
Name (First, Middle, Last):
Student ID #:
E-mail address:
Alternate e-mail address:
Local address:
Phone number:
USF School/College:
Major:
Cum. GPA:
Current standing:  

Expected graduation date:

Please list any courses completed or in progress that you find relevant to this program:

Course number
Title Instructor Semester/Year Grade Service-Learning (Y/N)

Statement of Purpose

Read the quotes and accompanying questions below and choose two of the three to which to respond. Statements will be judged according to both content and writing quality.
Please copy and paste or type in the box below your statement of purpose. Please proofread.

  1. "There isn't a student on this campus in any major who could not be an effective force in public decision-making if they bring to the fight a personal commitment to build a more just and humane world."- Leo T. McCarthy
    Provide specific examples of how you have demonstrated a commitment to building a more humane and just world. How will this program strengthen your capacity to continue this commitment?
  2. "You need a set of convictions based on moral values and you need to be introspective every day so you're truthful with yourself about how close you are to sticking to those values." - Leo T. McCarthy
    The McCarthy Center's core values that guide our work include: diversity and inclusion, social justice, collaboration and co-determination, humility, innovation, growth and improvement, and invitational dialogue.
    Choose two of the values from the McCarthy Center's list of Core Values and discuss why they resonate with you. How will
    you incorporate them during your DC experience?
  3. "If a moral commitment does not drive a person in public office, he or she will waiver and maybe wither in the face of all the forces that may tear him/her apart." - Leo T. McCarthy
    Public servants may be challenged by internal forces such as apathy, fear, and bias, as well as external forces including systemic injustice and bureaucratic red tape.
    Provide one specific example of both an internal AND an external force that have challenged or threatened your moral commitment to service and describe how you strive to overcome those forces. 


Resume

Please email your most recent resume to the McCarthy Center at mccarthycenter@usfca.edu. Your application will not be considered complete until your resume is received.


Reference Letter

Please provide the contact information for one professional or academic reference who is familiar with your skills and abilities. This could be a colleague, a professor, or an employer. Please do not list a family member or peer/friend.
This person should compose a letter of recommendation on your behalf and email it to mccarthycenter@usfca.edu by March 8th.

Name of Referee  
Title/Relation  
Primary Phone  
Email  

Interview Availability

Should you be selected for an interview please select your available time slots below, choose multiple.

Check all available 1-1:30pm 1:30-2pm 2-2:30pm 2:30-3pm 3-3:30pm 3:30-4pm 4-4:30pm 4:30-5pm
Wednesday, March 25
Check all available 9-9:30am 9:30-10am 10-10:30am 10:30-11am 11-11:30am 11:30-12pm 12-12:30pm 12:30-1pm
Thursday, March 26

My signature below certifies that the above information is true.

ATTENTION: Once you hit the “submit” button, a message should appear confirming that your application was submitted successfully. If you do not see this message, please either try to resubmit your application or contact us to make sure we did receive it.

Signed:

Date: (mm/dd/yy)