Current Student-Document Request Form

Download a blank fillable Current Student-Document Request Form in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Current Student-Document Request Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.


David Geffen School of Medicine at UCLA
Office Use Only
Student Affairs Office
Date Received
12-159 CHS, Box 951720
Amount Paid:
Los Angeles, CA 90095-1720
Date Completed
: __________________
Phone: 310-206-0434 / Fax: 310-794-9574
Current Student - Document Request Form
Not to be used for 4
year Away Elective Document Requests
Please allow
5-10 business days for processing, upon
receipt, depending on time of year and volume of requests. Please submit
document requests at least 2 weeks prior to any application or certification deadlines so we may better serve you.
The completed form(s) can be returned via email at, fax 310-794-9574 or by returning to the Registrar’s mailbox
in 12-159 CHS.
The SAO office hours are: M – F; 8:00am – 5:00pm.
Student Information - Please Print Clearly
Full Name: ______________________________________
Class of: _________
SID #: _____________________________
Contact Information (phone or MedNet Email): __________________________________________________________________
Signature: ________________________________________
Date: _________________________
Authorization signature required: I authorize release of information as directed on this Document Request Form
- Recipient address required in space provided below regardless of delivery method
Official Transcript
Returned in sealed envelope
with Dean’s signature/University embossed seal
# of Copies
Unofficial Transcript
# of Copies
Place in sealed envelope
not printed on transcript paper
Letter of Enrollment Verification
# of Copies
Place in sealed envelope
Letter of Good Standing
# of Copies
Place in sealed envelope
Jury Duty **-
Letter of exemption describing current registration and time requirements as a medical student. List full courthouse address
** Please note, you are responsible for sending the Letter of Exemption and Summons together to the courthouse
Juror ID # ___________________________
Reporting Location #: _______
Group # : _______
Other (please specify): _______________________________________________________________________________
Special Instructions (please specify): ___________________________________________________
Loan Deferment Request – Cannot be completed by SAO.
Form must be completed by the School of Medicine FAO (12-109CHS)
Letter of Recommendation (scholarships, research, etc.)– Cannot be completed by Registrar.
Please complete Dean’s Letter of Recommendation form:
Sending Instructions
Please clearly print name and complete address to which document(s) should be addressed to. Complete a separate
Document Request Form when sending document(s) to multiple addressees.
I would like to PICK UP - you will receive an e-mail when
Regular Mail
Express Mail
($20.00 via UPS)
the document(s) is available to pick up.
Completion of this section REQUIRED
regardless of delivery method.
Complete recipient address to which you would like document(s) sent.
*SAO will not fax official transcripts
EMAIL TO: ___________________________________
*SAO will not email official transcripts
Last Updated: 2/1/2016


00 votes

Related Articles

Related forms

Related Categories

Parent category: Business