Background Check and Drug Test Order Request
Date form was submitted
*
/
Month
/
Day
Year
Date
Name
*
Last Name
First Name
UIW Identification Number
*
Phone Number
*
Please enter a valid phone number.
UIW Email Address
*
Confirmation Email
What is your status with UIWSOM?
*
Current DO student (Class of 2026, 2027, or Class of 2028)
Incoming DO student (Class of 2029, which starts in July 2025)
Incoming MBS student
Returning MBS student
Which service do you need to order?
Both (Background Check and Drug Test)
Background Check only
Drug Test only
Submit
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