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Forms

Absences

  • Extended absence request form: For students who request consideration for an absence defined as a period of time from 6 to 15 consecutive class days, the extended absence may be considered. Please see the extended absence process in the ATSU University Catalog.
  • Student leave request form: For students who anticipate being unable to participate in all course requirements or activities for periods of time beyond 15 consecutive class days, the student must petition for a leave. More information on the student leave policy, including additional documentation needed for the petition to leave may be found in the ATSU University Catalog.

Diploma replacement or duplicate request form

To order another copy of an ATSU diploma, graduates should complete the diploma replacement or duplicate request form and submit the form, along with payment to the Registrar’s Office.

Enrollment or degree verifications

Students, graduates, and former ATSU students may request a letter verifying their enrollment or graduation from ATSU by completing the ATSU verification request form.

NOTE: Students can obtain immediate enrollment verification certificates for free through the National Student Clearinghouse 24/7! Log in to the ATSU Portal at my.atsu.edu, click on Resources, Academic Resources, and National Student Clearinghouse. Use your ATSU username and password to access the Student Self-Service tool.

External graduate student fellowship application

The external graduate student fellowship application is required in order to be considered for an A.T. Still University approved external graduate student fellowship. Please see the A.T. Still University external graduate student fellowship policy in the ATSU University Catalog for more information.

FERPA: Nondisclosure of directory information form

Under the Family Educational Rights and Privacy Act (FERPA), students have the right to block the release of items considered by ATSU to be directory information. If a student wants to deny access to one or more personally identifiable pieces of directory information, the student would need to complete the nondisclosure of directory information form.

Letter of recommendation release

Faculty or staff members that have been asked by a student to write a letter of recommendation may use the letter of recommendation – permission to release education record information form. This form allows the student to indicate the information that is needed in the letter along with permission to disclose personally identifiable information otherwise protected by FERPA.

MSPE and LOR copies

Requests for KCOM Medical Student Performance Evaluations (MSPEs) and Letters of Recommendation (LORs) to be sent to residency programs, etc. may be sent via the KCOM Academic & Clinical Educational Affairs MSPE and LOR request form.

Name change

Current students and graduates requesting a name change on their academic records are required to submit a name of record change request along with one of the following documents:

  • Copy of marriage license
  • Copy of court order authorizing the name change (i.e. divorce decree)
  • Non-U.S. citizens may provide a copy of passport

Re-admission application

In most instances, student withdrawing from ATSU, regardless of the reason, must apply for re-admission. To apply for re-admission, the applicant should submit the application for re-admission. For more information on the Re-admission Policy and Procedures, please review the ATSU University Catalog.

Transfer credit application

Those wishing to submit prior credit for review for transfer credit should review the Transfer Credit policy and corresponding program-specific transfer credit policies in the ATSU University Catalog. If all requirements are met, an application to transfer academic credit should be completed and submitted per the ATSU University Catalog instructions.