Alumni Request for Medical Education Verification Header Image

All MSPE letters will be emailed as an encrypted  PDF File.Your signature below indicates your agreement not to alter the MSPE letter. It also serves as attestation  that: "the undersigned, declares under penalty of perjury (under the policies of the University of Colorado School of Medicine) that the foregoing is true and correct and that they are the individual stated. In the event of identity theft or false representation, the individual shall be prosecuted to the full extent of the law".

Select who is requesting a copy of the document.
Student's Name*
Student's Previous Name (S)
Student's Date of Birth*
.
What documents are you requesting?
Please upload a signed release form from the physician in question*
No File Chosen
File uploads may not work on some mobile devices.
Please upload verification form to be completed.*
No File Chosen
File uploads may not work on some mobile devices.
Use your mouse or finger to draw your signature above. I, the undersigned, declare under penalty of perjury (under the policies of the University of Colorado School of Medicine) that the foregoing is true and correct and that I am the individual stated. In the event of identity theft or false representation i shall be prosecuted to the full extent of the law.