Licensure Forms

Most states require that the School of Medicine complete educational verification paperwork. You can submit this paperwork through the tool below and we will complete and submit the forms.  There is no charge for this service.

Please submit your licensure paperwork here:

Licensure Paperwork

  • Enter any other name that you have been known by
  • Please enter the year that you completed/ expect to complete your degree.
  • Please enter your date of birth to assist us in locating your records
  • Please enter the contact name for intended recipient.
  • Please enter the email for the intended recipient, if your wish for it to be emailed
  • If you would like the licensure paperwork mailed, please enter the mailing address for the intended recipient
  • Please provide a contact email, should we have questions
  • Please provide a contact phone number
  • Drop files here or
    Accepted file types: jpg, pdf, gif, tiff, bmp, doc.
    Please attach the required forms for the certification
  • Please enter any additional instructions or questions

If you cannot use the form, you can mail your request to:

Office of Student Affairs

Attn: Credentialing

PO Box 800739
Charlottesville, VA 22908