A state certifying agency professional education verification form (Licensure) is a document that is part of the application packet required by some state agencies for verification of a degree earned by a medical professional. It may be referred to as a medical education verification form, certification of medical education form, certificate of professional training form, or other similar name.

Please be aware that SUNY Upstate Medical University does not provide this form for current or former students, nor do we provide advisement as to whether it is required for application to a specific certifying agency. The application process, for some U.S. states, territories, or The District of Columbia, requires both the academic transcript and completion of a verification form, and some require only the transcript or only the verification form. If you are applying for Licensure/Certification in the United States please refer to the state, territory, or D.C. licensure application instructions regarding requirements, of that agency, for verification of your medical education.

Please note that a fee of $5.00 is required to accompany each request for completion of a state certifying agency professional education verification form (Licensure).

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