Contact Update Form

Complete this form (alumni or student) when you have a name, address, or emergency contact change.

  • Name changes must be accompanied by legal documentation that confirms the new name.
  • Turnaround time is 1-7 business days (except during peak periods when it could be longer) and you will be contacted via email once your request is ready to be picked up, faxed or mailed.

Duplicate Diploma Form

Roseman University of Health Sciences issues only one diploma to each student.Only under special circumstances will a diploma be re-issued.

  • The reissued diploma will be printed exactly as the original except the current officer’s signatures will appear.  No name changes will be honored for previously issued diplomas.
  • The diploma will be marked with “Duplicate Diploma.”
  • Please enclose a check or money order (no cash) to the address on the form.  Also, enclose a clear copy of a government issued photo ID.  Upon receipt of the form and fee it will take 6-8 weeks for arrival of your diploma.

FERPA – Written Consent Waiver Form

The Family Educational Rights and Privacy Act of 1974, establishes that a post-secondary student has the right to inspect and review his/her academic records and generally prohibits outside parties from obtaining the information contained in these records without the student’s written consent. However, a student may waive the right to review certain confidential information, for example, letters of recommendation placed in the student’s file.

Enrollment/Graduation Verification Form

Our institution has authorized the National Student Clearinghouse to act as our agent for all verifications of student enrollment. Please visit the Clearinghouse online to verify enrollment information via a direct inquiry.

  • Henderson Campus Reference ID: 040653-00
  • South Jordan Campus Reference ID: 040653-01

Childcare

Also, complete this form if you require confirmation of your enrollment for childcare purposes. Turnaround time is 1-7 business days (except during peak periods) and you will be contacted via email once your request is ready to be picked up, faxed or mailed.

Jury Duty

Also, complete this form if you require confirmation of your enrollment for jury duty purposes. Turnaround time is 1-7 business days (except during peak periods) and you will be contacted via email once your request is ready to be picked up, faxed or mailed.  For students who receive a jury summons, a copy of the summons should be submitted along with the Enrollment Verification form in advance of the day that you need to submit it for consideration of postponement or dismissal of jury duty.

Student Insurance Discount

Please attach the insurance paperwork with this form.

Transcript Request Form

Complete this form if you require a certified statement of your academic record at Roseman University.

Transcripts may be requested in two forms:

  1. Official transcripts bear the signature of the Registrar and are printed on official transcript paper (cost is $5.00 each).
    NOTE: When applying for residencies, scholarships, boards,     etc. an official transcript is required.
  2. Unofficial  transcripts do not bear the signature of the Registrar, are printed on plain paper, and are free.
  • Turnaround time on both official and unofficial transcripts is 1-7 business days (except during peak periods) and you will be contacted via email once your request is ready to be picked up, faxed or mailed.
  • Payment is made to the Bursar’s Office in the form of cash, check, money order, or debit/credit card or e-check.
  • If requesting an official transcript for licensure, address information for state boards can be found below (by program):
                  

Transcripts for Residencies – Instructions

Dental
Pharmacy

Transcripts for Licensure – Instructions

Dental
Pharmacy (states other than Utah)
Pharmacy (Utah licensure)

State Licensing Boards

Dental
Nursing
Pharmacy

Written Authorization Form

The Roseman University of Health Sciences (Roseman) does not release or accept any requests from anyone other than the student without written authorization. In order for the office of the Registrar/Student Services to release or accept such request the student must submit a Written Authorization Form for a Transcript/Enrollment & Graduation Verification prior to the requests being dropped off or picked up. If you have questions pertaining to the written authorization form please call the Registrar’s Office at or email us.