This form should be used to submit a Notarized "Clearance Letter" issued by a
Healthcare Entity Licensed by the Mississippi Department of Health to request clearance for
an engagement at UMMC. Documents uploaded here will be reviewed by UMMC Human Resources. This
form should be submitted by the person named below.
Examples of individuals who should use this form include affiliated students and individuals
onboarding through the ENEPAR process, but may also include those engaging with UMMC in other
capacities as well. If you are unsure if you should upload documents here, please contact Human
Resources at email@example.com.
Please provide the following information in order to complete your upload: