Southern Illinois University School of Medicine

$SIU School of Medicine\$
	Office of Student Affairs

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Student Records Forms

Authorization to Release Information Form (request official school records) (pdf) (MSWord).

Changes to Official Student Record (name, address, phone number etc.) (pdf) (MSWord)

Please Note: There is a $5.00 fee for each transcript requested. Please make check payable to Southern Illinois University School of Medicine.

Return completed form(s) to:

Jennifer Langley, Registrar
Office of Student Affairs
Southern Illinois University School of Medicine
P.O. Box 19624
Springfield, IL 62794-9624

For FedEx or UPS use:
801 North Rutledge Room 3080, Springfield, IL 62702
registrar@siumed.edu
Phone: 217-545-0890
Fax: 217-545-5538

Last updated February 27, 2008

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The mission of SIU School of Medicine is to assist the citizens of central and southern Illinois in meeting their present and future health care needs through education, clinical service and research.

Southern Illinois University is an Equal Opportunity/Affirmative Action institution in accordance with Civil Rights legislation and does not discriminate on the basis of race, color, religion, age, sex, handicap or national origin in any of its educational programs, activities, admissions or employment practices.

NOTE: Most of the forms on these web pages are in Adobe Acrobat Portable Document Format (PDF).