Educational Training Certificate Application Form

The Board recently adopted a rule allowing out-of state licensed physicians, in good standing, to enter this state for the sole purpose of participating in or providing educational training that involves the provision of patient care.

To be eligible for an educational training certificate, an applicant must complete the forms below, have the sponsor form signed by the head of the program, certifying that the applicant is or will be enrolled/instruct in the program.

General Information and Checklist

Educational Training Certificate Application Form

Form E- Affidavit of Citizenship Status

Form G- Application Power of Attorney (optional)