Alumni Verification Request Form

Use this form to process requests for:

  • MD verification
  • State licensure verification
  • Certification of diploma

Please note that several items require a signed release. Please download an Academic Record Release Form, sign, scan and submit with your Verification Request.

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png pdf doc.
Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png tif pdf doc docx.
Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png tif pdf doc docx.
Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png tif pdf doc docx.