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.

Download this pdf file.General Information and Checklist

Download this pdf file.Educational Training Certificate Application Form

Download this pdf file.Form E- Affidavit of Citizenship Status

Download this pdf file.Form G- Application Power of Attorney (optional)