Affiliated School Student Submission

Complete the information below and attach the affiliated student spreadsheet for the students in your school and program.

* - Required Fields

Affiliated School:*
Affiliated Program:*
Affiliated Program Coordinator:*
Affiliated Program Coordinator Phone:*
Affiliated Program Coordinator Email:*
Name of UMMC Contact*
File attachment*	*.txt,*.doc,*.docx,*.xls,*.xlsx,*.pdf, *.gif,*.jpg,*.jpeg,*.bmp,*.png,*.tif,*.tiff
By checking the following box, you are agreeing to the following: I am the Affiliated School Program Coordinator listed above and attest that all information provided on the affiliated student spreadsheet is accurate to the best of my knowledge. I attest that the documentation for all UMMC requirements as listed on the affiliated student spreadsheet are kept on file at the affiliated school and program listed above and will be provided to UMMC during future audits when requested.*	I agree