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
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