Registrar

Online Submission of Service Request

USU Medical Students and School of Medicine Graduates Only

Please select the 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:
(lost, damaged or name change)
(Further instructions on New/Replacement Medical School Diplomas)

 

Matriculation/graduation dates and degree received:
 

 

Letter of recommendation for

Dean's Letter/MSPE:

 

Other?:
(Licensure Form, Deferment Form, and any other Accompanying Document)

 

Specify Other:
 

 

Method of Fullfillment

I will Pick Up:

 

Please FAX to:

 

FAX Number:
 

 

Please Email to:

 

Email Address:
 

 

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:
 

 

Attention:
 

 

Mailing address:
 

 

City, State, Zip:
 

 

OR FAX information to:
 

 

A mailing address is REQUIRED for all documents to be forwarded to a third party, even if FAXing is requested, as the original document will then be mailed.

My identifying information is

Rank:
 

 

Date of Birth:
 

 

Full Name:
 

 

Service Branch:
 

 

Mailing address:
 

 

Graduation Year:
 

 

Daytime Telephone:
 

 

Duty/Home Address:
 

 

Daytime Telephone:
 

 

City, State, Zip:
 

 

Email Address:
 

 

Comments/Additional Information: