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:


(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:




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



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: