USC Health Sciences Campus Student (Non-Dental Program)
Library Card Registration Form
 
(Subject to verification)
* Required information
* E-mail address :
     
* Last Name : * First Name : Initial :
   
* Social Security Number : Student Number :
 
Address 1 (Health Sciences School Program) :

* BS MS MD Ph.D. Other, Specify:
* Medicine Nursing Occupational Therapy Pharmacy
   Physical Therapy Other, Specify:

   
* School / Department Room :
   
* Phone :
 
Address 2 (Current, local mailing address while a student at USC) :
Number and Street Name : Apartment / Condo / Suite No. :
   
City and State : Zip Code :
   
Current Phone Number : Beeper / Pager Phone Number :
 
Address 3 (Permanent mailing address if different from above, Address 2) :
* Number and Street Name : Apartment / Condo / Suite No. :
   
* City and State : * Zip Code :
   
* Home Phone Number :  
 
Use of your library card signifies agreement to comply with all University of Southern California and Health Sciences Libraries regulations and policies. This library card is non-transferable and you are responsible for all use made of this card. I understand I must present University ID at the Wilson Dental Library to activate this application.
 
* I agree. Yes