Use this form to request official student records including letter of academic standing, Medical Student Performance Evaluation (MSPE), transcripts, certified photocopies of diploma, or replacement of original diploma. 

Instructions

There is a $5.00 fee per transcript (no charge for currently enrolled students)There is a $15.00 fee for the replacement of the original diploma. Payment must accompany the request form. Please make checks payable to SIU School of Medicine. 

PLEASE RETURN COMPLETED FORM VIA MAIL, FAX, OR EMAIL TO:

Karla Hehner, Registrar 
Phone: 217-545-0890
Fax: 217-545-5538
Email: registrar@siumed.edu

SIU School of Medicine, Office of Student Affairs,
Room 3080
P.O. Box 19624
Springfield, IL 62794-9624