MUSM Registrar's Office Request Form

MUSM Registrar's Office Request Form - Former Students Only

Instructions
This request form can only be used by alumni who were enrolled in the School of Medicine at Mercer University. Requests are usually completed within 1 to 3 business days. During peak times, please allow a minimum of one (1) week for processing.

If you need to request an official electronic transcript, please order via the Parchment Portal - http://www.parchment.com/u/registration/33871/account. Transcripts ordered via Parchment are $3.00 per copy and $28.00 for rush orders.
Please note that only unofficial transcripts may be emailed from the Registrar's Office.

Last Name

First Name

MUID

Maiden Name

Address

City

State

Zip Code

Phone Number

Program of Study

Request Type (select all that apply)

Transcript (mail or pick-up)

MSPE/Dean’s Letter

Transcript and MSPE for MIDUS/ERAS

State Medical Board Licensure Form Only

State Medical Board Licensure Form and Official Transcript

Certified Copy of Diploma

Other Requests – please clearly state in "Special Instruction" box.

MD only

Graduation Date

Current Practice or Training Location

Special Instructions: Briefly describe any special instructions below. Do not restate instructions stated on certification forms from third parties.

Please provide complete mailing and/or email address for delivery of requested documents.

Upload all files associated with your request

By submitting this request, I am granting permission for Mercer University School of Medicine Registrar Office to release information to third parties.

Signature (please type)

Date