University of Kentucky
 
 

Resident/Fellow Verification Request

Use this form to request training verification for trainees from 1998 to the present. For verification requests for a trainee who completed training prior to 1998, send your request directly to gmerecords@uky.edu or by fax to 859-218-7521.

All residency and fellowship verification requests must be include a signed release statement. NO verifications will be processed without a signed release statement.

Please Note: The GME Office does not complete the following forms:

You must contact the training program directly to complete these forms. Search for program contact information on The ACGME website: (https://apps.acgme.org/ads/public/.

University of Kentucky Graduate Medical Education offers physician training programs in most medical and surgical specialties, and also offers training programs in dentistry, oral and maxillofacial surgery, pharmacy, optometry, pastoral care, medical physics, and health administration. GME only verifies training for the above listed program.


If you have questions, please contact gmerecords@uky.edu.

Certificate of Insurance and Malpractice Claims

For certificate of insurance requests, GME Credential Coordinator at gmeadmin@uky.edu

For run loss reports or claims history, please request from UK Risk Management at candice.cowan@uky.edu

If you have questions, please email me at mburk2@uky.edu


Resident/Fellow Information

Trainee Name*:
First*:

 Middle:
 Last*:
Trainee Aliases:
Approx. Graduation Year:
Residency/Fellowship Program:

Your Contact Information

Your Name*:
Company/Institution*:
Your Email Address*:
Phone Number:
Fax Number:
Address:
Street - Line 1*:

Street - Line 2:

Street - Line 3:

Street - Line 4:

City*:
 State*:
 Zipcode*:
Country*:

Authority for Release   (Required for Processing)

Scanned File:

Additional Comments/Notes

Additional Notes:

* required fields