LETTER REQUEST - Post Graduate Request

Fields with asterisks (*) are required.

First Name *

Middle Initial

Last Name (while enrolled in medical school) *

Contact Phone Number *

Email *

Year of Graduation *

Post Graduate Placement:

Hospital

City/State

Type of letter being requested *

Letter needed by date *

How do you want to receive your letter *

Recipient of letter:

Please Note: We cannot send the updated MSPE directly to you. As such, put the name of the program below, including name and address.

Name *

Address line 1

Address line 2

City

State/province/region

Postal/zip code

PLEASE NOTE: For MIDUS, you must create a request in the Supporting Documents Module on the ERAS Fellowship site. Once this request has been successfully completed, a link will be sent to our attention to allow us to upload the document into the Fellowship Portal. You will be asked for this information in order to complete the form:

Secretary
Juanita Stafford
Student Affairs
320 E Canfield/Ste 315
Detroit, MI 48201

Please include the email address jstaffor@med.wayne.edu in your request.