School of Medicine Service Request

Check items you are requesting

Medical School Student transcript (unsigned; for your personal use)

Official Medical School transcript (signed, sealed, and mailed to a third party)

Verification of Diploma

Replacement of Medical school diploma (instructions will be provided for this request.)

Matriculation/graduation letter of dates and degree received

Letter of recommendation for Dean's Letter/MSPE

Other (Licensure Form, Deferment Form, and any other Accompanying Document)- email form to registrar-online-request@usuhs.edu

Specify if Other

Method of Fulfillment

I will pick up

FAX

Mail

If FAX checked, specify FAX number and Contact

If Email checked, specify Email and Contact

Mail this information to

(You MUST provide a complete name and address of the receiving institution. Please use the COMMENT area for additional mailing instructions)

Institution Name

ATTN

Institution Mailing Address

Institution City

Institution State

Institution Zip

My identifying information

Rank

Date of Birth

YYYY

Full Name

Service Branch

Graduation Year

Daytime Phone

Mailing Address

City

State

Zip

Personal Phone

Comments/Additional Information

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