Request for MSPE Letter

(Please allow 3-4 weeks for processing)
Once a MSPE Letter request is received it will be processed. Due to the high volume of requests we are unable to hold letters for future rotations to be completed.

(*Required)

*First Name:

*Last Name:

*Phone:

*Email

*Street Address

Address 2

*City

*State

*Zip/Postal Code

*AUC Student ID#:

*AAMC # (for ERAS):

*AUC Start Date:

*Graduation Date:

*Education

*Date Received: (mm/yy)

*College/University

*Location:

*Education

*Date Received: (mm/yy)

*College/University

*Location:

*Education

*Date Received: (mm/yy)

*College/University

*Location:

*Is this your first time applying to the Match?

If no, then what years did you apply to the Match?

USMLE Step 1

*3-digit Score:

*2-digit Score:

*Test Date:

*USMLE Step 2 CK

*2-digit Score:

*Test Date:

Important Notice to ERAS Applicants about Letters of Recommendation (LoR): Please have those letters sent directly to ECFMG/ERAS along with a copy of the ERAS Document Submission Form and the ERAS LoR Cover Sheet.

Curriculum Vitae (resumé)
Please copy and paste below:

Unique Characteristics Questionnaire
Please answer the following questions as they pertain to your time in MEDICAL SCHOOL:

1. Have you received any honors or awards? If so, which ones and for what reason? Please indicate whether they were during your basic sciences or clinicals and the date received. Please give the proper name of the award and the organization that awarded it.

2. Have you been involved in any research? Please describe your role in it, as well as the title, publication date (if applicable), and the publication it appears/will appear in. For posters, please indicate where the poster was presented.

3. Have you done any teaching or tutoring? Please indicate if it was an AUC-sanctioned position or an outside tutoring or teaching job.

4. Have you done any volunteer work or community service while inmedical school? Please indicate with which organization, the nature of the work, and your specific role in it, as well as a timeframe during which it was performed.

5. Have you taken on or been elected to any leadership roles? These can include, but are not limited to: student government positions, committee roles, government within an organization such as AMSA or Phi Chi, and so on.

6.What organizations were you a part of in medical school? Please indicate the name of the organization, the nature of your role in the organization, what kind of work you may have done, projects participated in, etc.

7. Did you take on any in-school service positions such as Orientation Advisor, Resident Advisor, etc?

* Please be aware that theMSPE is not a letter of recommendation. The letter serves to highlight your academic achievements and community service work, on campus or off, that are relevant to your medical education and were completed during your medical education.

Please indicate NUMBER OF MSPE LETTERS to be sent to each recipient:

* To ECFMG/ERAS/EFDO:

*To Student/Applicant:
(to address at top of form)

A free e-mail copy will be sent to the student or graduate for review.

To Other Recipient 1:

Recipient Name:

Hospital Name:

Street Address:

City:

State:

Zip:

To Other Recipient 2:

Recipient Name:

Hospital Name:

Street Address:

City:

State:

Zip:

Non-refundable fees: Students $10.00 Graduates $15.00

*Total Number of Letters X appropriate fee =


Request for MSPE Letter (Please allow 3-4 weeks for processing) Once a MSPE Letter request is received it will be processed. Due to the high volume of requests we are unable to hold letters for future rotations to be completed.

(*Required)

*First Name:
*Last Name:
*Phone:
*Email
*Street Address
Address 2
*City
*State
*Zip/Postal Code

*AUC Student ID#:
*AAMC # (for ERAS):
*AUC Start Date:
*Graduation Date:

*Education
*Date Received: (mm/yy)
*College/University
*Location:

*Education
*Date Received: (mm/yy)
*College/University
*Location:

*Education
*Date Received: (mm/yy)
*College/University
*Location:

*Is this your first time applying to the Match?
If no, then what years did you apply to the Match?

USMLE Step 1
*3-digit Score:
*2-digit Score:
*Test Date:

*USMLE Step 2 CK
*3-digit Score:
*2-digit Score:
*Test Date:

Important Notice to ERAS Applicants about Letters of Recommendation (LoR): Please have those letters sent directly to ECFMG/ERAS along with a copy of the ERAS Document Submission Form and the ERAS LoR Cover Sheet.

Curriculum Vitae (resumé) Please copy and paste below:


Unique Characteristics Questionnaire Please answer the following questions as they pertain to your time in MEDICAL SCHOOL:

1. Have you received any honors or awards? If so, which ones and for what reason? Please indicate whether they were during your basic sciences or clinicals and the date received. Please give the proper name of the award and the organization that awarded it.


2. Have you been involved in any research? Please describe your role in it, as well as the title, publication date (if applicable), and the publication it appears/will appear in. For posters, please indicate where the poster was presented.


3. Have you done any teaching or tutoring? Please indicate if it was an AUC-sanctioned position or an outside tutoring or teaching job.


4. Have you done any volunteer work or community service while inmedical school? Please indicate with which organization, the nature of the work, and your specific role in it, as well as a timeframe during which it was performed.


5. Have you taken on or been elected to any leadership roles? These can include, but are not limited to: student government positions, committee roles, government within an organization such as AMSA or Phi Chi, and so on.


6.What organizations were you a part of in medical school? Please indicate the name of the organization, the nature of your role in the organization, what kind of work you may have done, projects participated in, etc.


7. Did you take on any in-school service positions such as Orientation Advisor, Resident Advisor, etc?


* Please be aware that theMSPE is not a letter of recommendation. The letter serves to highlight your academic achievements and community service work, on campus or off, that are relevant to your medical education and were completed during your medical education.

Please indicate NUMBER OF MSPE LETTERS to be sent to each recipient:

* To ECFMG/ERAS/EFDO:

To Student/Applicant: (to address at top of form)* A free e-mail copy will be sent to the student or graduate for review.

To Other Recipient 1:
Recipient Name:
Hospital Name:
Street Address:
City:
State:
Zip:

To Other Recipient 2:
Recipient Name:
Hospital Name:
Street Address:
City:
State:
Zip:

Non-refundable fees: Students $10.00 Graduates $15.00

*Total Number of Letters X appropriate fee =