Graduate Services

Graduate Services

Payment of Document Certifications, and MSPE
Student Name*

First NameLast Name
Student ID*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
If applicable, where should your documents be sent?

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Diploma Replacement or Copy*

Medical Student Performance Evaluation (MSPE) / Dean's Letter

$30.00 Quantity

Diploma Certification

$30.00

Document Notarization

$75.00 Quantity

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Signature*

Clear
Any payments made in accordance with this form submission shall, once they are paid, not be refundable nor creditable for any reason whatsoever.
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