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UCLA Latinxs/Chicanxs for Community Medicine: 25-'26 Membership Application

Holaaa! 😊 

Bienvenidos to LCCM! Whether you’re a new or returning member, we are so excited to have you as part of our growing community. We are currently accepting everyone and are excited to have you join us.

We invite you to take a few moments to fill out this brief application. Your responses will help us learn more about you, your interests, and your expectations, so we can create a meaningful space that truly supports you.

Our goal is to cultivate a community where every member feels valued and empowered. By sharing a little about yourself, you’ll help us shape experiences that are enriching and impactful for all.

We are delighted to have you join us and look forward to supporting your growth while fostering meaningful connections and experiences within our community.

En comunidad y armonía, 
Fiorella Garcia Rodas (She/Her/Ella), Lupita Diaz Garcia (She/Her/Ella), and Samantha Hernandez (She/Her/Ella) 
LCCM External, Internal, and Admin Coordinators (2025-2026)
Email: lccm.external@gmail.com, lccm.internal@gmail.com, and lccm.admn@gmail.com 

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Personal Information
Name (First, Last) *
Preferred Email (to receive our weekly newsletter) *
Pronouns *
Phone Number *
Hometown *
Age *
Major *
Minor *
Academic Standing *
Graduating Year *
Are you a transfer student? *
Racial/Ethnic Background *
What are your professional goals? *
Required
Are you a returning member? *
How did you hear about LCCM? *
What do you hope to gain from LCCM? *
What kind of guest speakers are you interested in hearing  from? *
Required
What types of resources would you be interested in? *
Required
If you are a returning member, how do you think LCCM can improve?
Question, Concern, or Comment?
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