2019 CRA - Acknowledgement of Medical School

DEADLINE: March 4, 2019

1. Proof of enrollment at a Medical SchoolPlease complete one form for each medical student

This is to certify that (name of student)

is a medical student at (name of institution)

2. *This question is required.

3. Name of Dean/Designate *This question is required.

4. Signature(be sure to include your name at bottom of signature box)

Signature of

5. Date *This question is required. This question requires a valid date format of MM/DD/YYYY.

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