Medical School

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Enrollment Verification Request Form

Requests for written verification of medical student enrollment at the Medical College of Wisconsin can be made by completing the form below. There is no cost to the student for this service.

The verification letter contains the student's name, anticipated date of graduation and a statement that the student is enrolled full-time in the Doctor of Medicine degree program.

Students can also bring in forms that need to be completed rather than have a letter produced. Forms are usually used for deferments, insurance or the military.

Items in bold are required fields.

First Name:  Middle Name:  Last Name:  

Year in School:  M-1  M-2  M-3 M-4 or Class Year: 

I am requesting a letter verifying my enrollment for:

If indicated "other" above, please specify: 


Please indicate how you would like to receive the enrollment verification letter.

 I will pick up this letter.

 E-mail it to:

 Mail enrollment letter to: 

Name:

Street 1:

Street 2: 

City:  State:   Zip:


E-Signature of Student (please type):  AAMC ID:

MCW e-mail address:

 

 

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Page Updated 07/24/2014