Get Uva Authorized Medical Physicist Application 2019-2026

This guide provides step-by-step instructions on how to successfully fill out the UVA Authorized Medical Physicist Application online. By following these detailed instructions, users can ensure that they complete the application accurately and efficiently.

Follow the steps to complete your application successfully:

1. Click ‘Get Form’ button to obtain the UVA Authorized Medical Physicist Application form and open it for editing.
2. In Part 1, provide your name (Last, First, MI) in the designated fields, ensuring you print clearly.
3. Enter your UVA Computing ID (e.g. drr2c) in the required field.
4. Indicate whether you are currently an Authorized Medical Physicist (AMP) on any relevant licenses by selecting 'Yes' or 'No'. If 'Yes', include the license number and agency.
5. If you answered 'No' to the previous question, specify if you are board certified. If 'Yes', include a copy of the certification. If 'No', indicate that you will complete the required training experience and submit the relevant documentation.
6. Indicate the modalities for which you are requesting authorization by checking the appropriate boxes (e.g., HDR, Teletherapy, Emerging Technology).
7. Review the application and certify that all information provided is accurate by signing and dating the application at the end of Part 1.
8. Compile and submit any additional required documents, and return the completed application form via email to the Radiation Safety Officer (RSO).

Complete your application online to ensure timely processing and authorization.