Student Request Form (Srf) - University Of Illinois College
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1Office of Student Affairs • College of Medicine (MC 785) • 1853 West Polk Street • Room 112 CMW • Chicago, Illinois 60612 • 312-996-2450 • Fax: 312-993-3787
Student Request Form (SRF)
UIC College of Medicine students can request documents through this Student Request Form (SRF). Some documents
may require you to submit additional paperwork to complete your request. Fill in the form below and make sure to save a
copy of the word document. Attach the form along with any supporting documents and send to your corresponding OSA
advisor. You may also submit a hard copy of the SRF at the Office of Student Affairs. Requests for letters may take 5
business days to complete upon receipt of the SRF form and supporting documents.
Mr./Ms.:
First Name:
Last Name:
UIN:
Phone #:
Email:
Graduation Class:
I am requesting the following letter(s) or immunization records request(s):
1.
Good Standing Letter – Certifies a student’s status and expected graduation date, signed by an OSA dean.
Support Exemption from Jury Duty – Submit a copy of the original summons to OSA.
2. I am requesting the following letter(s) or item(s) or immunization records:
Request will be completed by the Registrar’s Office
Good Standing Letter with malpractice and health insurance coverage - Letter is signed by the Registrar.
Completion of externship application – Submit a copy of the externship application.
Financial Aid Letter – Submit the student loans deferment form (if applicable).
Request a hard copy of student immunization records on file for Non-Certified Background users. (dates of
.uic.edu/studentgrades)
immunization records are available through APEX,
I am requesting a recommendation letter for a fellowship/award:
3.
Requests are routed to your assigned OSA advisor, select your OSA advisor from the drop down menu.
Timeah Rogers
Amber Lyman
Andy Pham
Alexa Richmond
Choose Your Advisor
Janine Sacco
Nabeela Rabbani
Melissa Hernandez
Stacey Walters
Mark Urosev
Please attach the following documents in order to complete your letter of recommendation:
Current CV
Personal Statement (if applicable)
Application for which you are requesting a letter of support and description of award/scholarship
Complete the Letter of Recommendation Template (on the SRF website) and attach it to the email message.
Other Requests/Comments:
Include the name, title, address, phone, and fax numbers for whom the letter should be addressed to. Letter can not be
addressed “To Whom it May Concern.”
Office Use Only:
Office Use Only - SRF Rec’d by: ___________________ Date Completed_______________
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