Name

Preferred Name:

Home Address

City State Zip Code

USC Address/PO Box

City State Zip Code

Home Phone:

Cell Phone:

Date of Birth:

Intended Major

Ethnicity:

Sex:

Email:

Please answer the following.  

1) Please list high school activities and organizations to which you belong or participate.

2) Please list community activities and organizations in which you are involved.

3)  Briefly explain why you are interested in participating in the M.A.P.P Program.

4) Please provide a few personal details that may be used in pairing you with a M.A.P.P. Counselor. (favorite food, hobby, music preference, etc.)

Upon receiving your application, we will send you information about the Minority Student Welcome and additional information about the M.A.P.P. Program.