University of Southern California Herman Ostrow School of Dentistry

1. Have you ever had any certification, registration, license, or clinical privileges revoked, suspended, or in any way restricted by an institution, state, or locality? If so, please explain.

2. Have you ever had any certification, registration, license, or clinical privleges revoked, suspended, or in any way restricted by an institution, state, or locality? If so, please explain.

1. Have you previously applied to the Herman Ostrow School of Dentistry at USC? If so, did you participate in an interview?

2. Have you previously applied to the Herman Ostrow School of Dentistry of USC? If so, did you participate in an interview (2000 characters)?

1. Please list any additional achievements or upcoming experiences that you want to share. (e.g., Your research is being published, or you have been elected to a leadership position within a club.)

2. Please list any additional achievements or upcoming experiences that you want to share. (e,g,, Your research is being published, or you have been elected to a leadership position within a club)

1. Have you taken any classes at a community college? If so, list each institution's name and the number of units you have completed.

2. Have you ever been disciplined for academic performance (e.g., academic probation, dismissal, suspension, disqualification, etc.) by any college or school? If so, please explain.

3. Have you ever been disciplined for academic performance (e.g., academic probation, dismissal, suspension, disqualification, etc.) by any college or school. If so, please explain.