91ɫƵ Department of Anesthesiology Verification of Residency or Fellowship
We provide training verifications upon request.
Verifications for internships, residencies, and fellowships completed more than one year ago are subject to the following fees, payable by credit card or check:
- $25 for each standard verification letter
- $75 for detailed verification of training
If we are unable to provide a verification (i.e., we have no record of the individual in question) you will be notified by email and you will not be charged.
Instructions for requesting training verification
Please submit the following documents alongside your verification request:
- A completed Verification Request Form (PDF)
- An Authorization for Release of Information signed by the trainee
- Your own verification form (if needed)
Please submit the forms to:
- Kourtney Mangan (kmangan@mcw.edu) for Residency verification
- Sarah Pritchard (spritchard@mcw.edu) for Adult Cardiothoracic Anesthesiology, Critical Care Medicine, Neuroanesthesia, Pain Medicine and RAAPS fellowships verification
- Rachel Smith (rasmith@mcw.edu) for Obstetric Anesthesiology and Pediatric Anesthesiology fellowships verification
Alternatively, completed forms may be faxed to (414) 805-5915 or submitted via US mail to the following address:
91ɫƵ
Department of Anesthesiology
ATTN: Kourtney Mangan
9200 W. Wisconsin Ave.
Milwaukee, WI 53226
Standard verification information
- Name of trainee
- Training program(s)/Specialty
- Dates of training
- Confirmation of successful completion of program(s) or
- Explanation and further information if program not successfully completed
Detailed verification information
- Standard verification information
- Specific privileges and/or procedure training if requested
- Information from performance evaluations if requested
Payment information
Checks are to be made out to 91ɫƵ - Dept. of Anesthesiology Education Div. and sent to:
91ɫƵ
Department of Anesthesiology
ATTN: Samantha Cusick
9200 W. Wisconsin Ave.
Milwaukee, WI 53226
Tax ID number: 39-0806261