Request for Internal Medicine Internship and Residency Postgraduate Training Verification

Fee Notification

$100.00 for each form.

Requests will only be processed with payment and must include: Full name at the time of training, date of birth, and with an original/wet or notarized digital signature authorization. A DocuSign release/consent is also acceptable.

To pay by credit card, please call the cashiers office at 904-244-3500 and reference Account# 71160 for payment of training verification. Ask for a receipt number AND the approval code and email both to lorna.matos@jax.ufl.edu. Once payment is processed, the verification may be completed within 5-10 business days based on the availability of the Program Director for signature. Please allow sufficient time for processing.

Payment by check may be submitted with the written request and made payable to UFJPI Account# 71160 and mail to:

Department of Medicine
Attention: Lorna Matos
653 W 8th St, Box L18
Jacksonville, FL 32209-6511

Please email your documents to lorna.matos@jax.ufl.edu.