Get Supplemental Qualification Statement

The Supplemental Qualification Statement is a crucial document for Medical Officer and Dental Officer positions. This guide will provide clear, step-by-step instructions to help you complete the form accurately and efficiently online.

Follow the steps to successfully complete your Supplemental Qualification Statement.

1. Press the ‘Get Form’ button to access the Supplemental Qualification Statement and open it for editing.
2. Enter your name in the designated fields provided — include your last name, first name, and middle name.
3. Fill in your address by providing the number, street name, city, state, and zip code in the respective fields.
4. In the Basic Professional Training section, list the name and location of the school where you received your medical or dental training.
5. Select the type of degree you obtained by checking the appropriate box: MD, DO, or DDS. Then, indicate the date you received your degree.
6. If your degree was obtained from a school outside of the U.S., indicate whether you have passed the Education Council for Foreign Medical Graduates examination by checking 'Yes' or 'No' and providing the date received.
7. In the Internship section, detail the type of internship and specialty, including the name and location of the hospital, the chief of service or program director, and the dates you attended.
8. For Residency Training and Fellowship, provide the name of the specialty, hospital details, chief of service or program director, and the dates attended.
9. In the Other Graduate Education section, enter the major field of study, institution details, certificate received, and attendance dates.
10. Answer the Certification by a Specialty Board questions. Indicate eligibility for certification and board certification status by selecting 'Yes' or 'No'. If applicable, provide the name of the specialty board, specialty, and date of certification.
11. Finally, review all provided information for accuracy. Once completed, you can save changes, download the document, print it, or share it as necessary.

Complete your Supplemental Qualification Statement online today for a smoother application process.