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Get Pennsylvania Verification Medical Education Form 2013-2024

ON: Submit the verification of medical education form to your medical school and request the school return the completed form directly to the Board in an official school envelope. SECTION 2 TO BE COMPLETED BY DEAN OR REGISTRAR OF MEDICAL SCHOOL NAME OF MEDICAL SCHOOL: NAME OF MEDICAL STUDENT: Last First Middle Month Day Year Month Day Year DATE STUDENT BEGAN TO ATTEND THIS MEDICAL SCHOOL: DATE OF GRADUATION: I CERTIFY THAT ALL OF THE INFORMATION LISTED ABOVE IS CORRECT SIGNATURE.

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