State medical board medical education verification form (Licensure)
A state medical board medical education verification form (Licensure) is. . . a form required by a State Medical Board to verify the degree earned by a medical professional. It may be referred to as a medical education verification form or a certification of medical education form.
How to request completion of a state medical board medical education verification form (Licensure):
Complete our Request Formtext, sign it and either fax, mail or bring it to us in person. To protect the confidentiality of academic information, Federal law requires your signed consent to release information from your academic record. Not even a parent may receive this information without your signed release. (Federal Family Rights and Privacy Act of 1974 -Buckley Amendment) That is why no phone, e-mail, or third party requests can be accepted Make certain you do not owe money to the University.
State law prohibits the Registrar's Office from releasing a information from a student's record if he or she owes the University money, Pursuant to the Student Debt Obligation/Bankruptcy and Statute of Limitations (Section 302.1(j) Title B, Official Compilation of Codes, Rules and Regulations of the State of New York. Nor can a student's record be released if they are on the NYS Student Loan Service Center Loan Default List. If you owe the University money, you will be notified that your request cannot be processed until your obligation is satisfied. Contact the Bursar's Office to determine how to satisfy your outstanding obligation.
A fee of $5.00 is required to accompany every request for completion of a state medical board medical education verification form (Licensure). Please note that some state medical boards also require an official academic transcript to be included with the form. See the application instructions for the specific state to which you are applying for licensure, regarding requirements for verification of your medical education.
The $5.00 fee for completion of a state medical board medical education verification form (Licensure) includes postage, except Overnight Delivery, which is an additional charge of $25.00. Incorrect payments and requests are returned for correction. You may pay by cash, check, credit card or money order. Checks should be made out to SUNY Upstate Medical University. To pay by credit card you must submit your Credit Card type (VISA/Mastercard or Discover Card only), your account number, the expiration date and your signature authorizing the charge. You may also contact the Bursar's Office at (315) 464-5148 directly to relay your credit card information over the phone. Normal turn-around time for our office to process your request is 5-10 business days from the date that it is received in our office.
A request for completion of a state medical board medical education verification form (Licensure)may be mailed to:
SUNY Upstate Medical University
Office of the Registrar
155 Elizabeth Blackwell Street
Syracuse, NY 13210 or faxed to: (315) 464-8822
Please note that while a state medical board medical education verification form (Licensure) is acceptable to be received in the SUNY Upstate Registrar’s Office by FAX, a state medical board requires that the completed form include the Registrar’s original signature and the raised seal of the institution, so it must be send to the medical board by postal mail or courier.
