Letter of Good Standing Request Form

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You may request a letter of good standing for any reason and at any time during your enrollment at the Medical School. You might need a letter of good standing for an away elective, scholarship, fellowship, research application, or 3rd year clerkship.

In order to be considered in good standing you must:
- Be currently enrolled making satisfactory progress towards degree completion
- Have completed all Annual Regulatory training requirements

You must request your letter at least 14 days prior to the application due date or submission deadline. If you have any questions, please contact the Office of Student Affairs at studentaffairs@umassmed.edu.

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M-D-Y

First Name

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Last Name

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Expected Graduation Year

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Purpose of Letter

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If "Other" purpose, please explain

Letter needed by date

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M-D-Y

Do you need documentation of insurance coverage?

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Yes

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How do you want to receive your letter?

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School / Program / Scholarship Name

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Agency Contact First Name

Agency Contact Last Name

Agency Email

Contact Address line 1

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Contact Address line 2

City

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State

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Zip

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Please attest to completing the Annual Regulatory Training modules and provide the date completed.

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M-D-Y

Please attest to completing your Mask fitting and provide the date completed.

M-D-Y

Mask Fit Testing Documentation:
Please upload a photo of your mask fit test paperwork here

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Additional Information

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By checking this box you are requesting that the Office of Student Affairs checks your current academic status and standing with the University, issue a Letter of Good Standing, have completed the Annual Regulatory Training and Mask fitting as requested above.

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