UNIVERSITY OF MEDICINE AND DENTISTRY OF NEW JERSEY



UNIVERSITY OF MEDICINE AND DENTISTRY OF NEW JERSEY

NEW JERSEY MEDICAL SCHOOL

Registrar’ Office

Request For Verification of Enrollment At NJMS

DATE DEGREE RECEIVED _________ ______ UIN _________________ DOB ___________

STUDENT NAME_____________________________________________________________________

(LAST) (FIRST) (MIDDLE)

I would like to request a letter stating that I am a full-time student sent to:

______________________________________________________________________________________

(NAME)

______________________________________________________________________________________

(STREET)

______________________________________________________________________________________

(CITY) (STATE) (ZIP CODE)

___________________________________ ____________________________________

SIGNATURE DATE

OR check box to pick up verification letter at REGISTRAR’S OFFICE

If you would like a certification letter sent to your address, please indicate address below.

______________________________________________________________________________________

(NAME)

______________________________________________________________________________________

(STREET)

______________________________________________________________________________________

(CITY) (STATE) (ZIP CODE)

___________________________________ ____________________________________

SIGNATURE DATE

Please return to:

University of Medicine and Dentistry of New Jersey

New Jersey Medical School

Registrar’s Office MSB B-640

P.O. Box 1709

185 South Orange Avenue

Newark, NJ 07101-1709

OR FAX TO: 973-972-6930

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download