New Grad Physician Assistant: Required Forms and General Information

IMPORTANT INFORMATION REGARDING APPLICATIONS AND SUBMISSIONS

 

ALL APPLICATIONS MUST be submitted via our EGov Portal: New Grad License Application

 

APPLICATIONS WILL NOT BE REVIEWED WITHOUT APPLICATION FEE OF $300.00.


Payment MUST include AA/PA’s name and GA license # for correct processing.

 

AVAILABLE FORMS TO DOWNLOAD AND SUBMIT

(YOU MAY NOT NEED ALL OF THESE, REFER TO THE CHECKLIST TO GET IT RIGHT THE FIRST TIME!)

 

Download this pdf file. PLEASE CLICK HERE FOR A SIMPLE CHECKLIST OF REQUIREMENTS FOR NEW GRAD PA/AA APPLICATIONS

 

Download this pdf file. FORM A - Affidavit of Applicant

Download this pdf file. FORM A2 - Citizenship Affidavit

Download this pdf file. FORM B - Request for Additional Duties

Download this pdf file. FORM C - Anesthesia Reference

Download this pdf file. FORM D - Primary Care Reference

Download this pdf file. FORM E - Anesthesia Basic Job Description

Download this pdf file. FORM F - Primary Care Basic Job Description

Download this pdf file. FORM H - SEPARATION NOTIFICATION

Download this pdf file. FORM I - Verification of Other State License

Download this pdf file. FORM J - Specific Power of Attorney

Download this pdf file. FORM K - Certificate of Education

Download this pdf file. PA/AA Utilization Form