Educational Records Release Form

Dear Doctor,

The University at Buffalo Office of Graduate Medical Education requires primary source verification of your medical/dental school degree for your residency file in addition to a copy of your diploma. Your medical/dental school may require signed authorization in order to release this information.

Please complete the form at the bottom of this page allowing us to verify your educational records. Please feel free to contact us with any questions.

Sincerely,

I consent to the release of information required to verify my degree to the University at Buffalo Office of Graduate Medical Education.