Get Ca 07a-100 L5 2019-2025

The CA 07A-100 L5 form is essential for international medical school graduates seeking certification of clinical training in California. This guide provides clear and concise instructions to facilitate the online completion of this important document.

Follow the steps to efficiently fill out the CA 07A-100 L5 online

1. Click the ‘Get Form’ button to obtain the form and access it in your online editor.
2. Begin by entering the legal name of the applicant in the designated fields, ensuring accuracy in the last name, first name, middle name, and any suffix.
3. Input the date of birth in the specified format (m/dd/yyyy) and provide the last four digits of the U.S. social security number or individual taxpayer identification number.
4. List the medical school of graduation, ensuring it is completed in the English language as specified.
5. Detail the undergraduate clinical clerkships the applicant participated in, focusing solely on hands-on diagnosis or treatment. Use one line per clinical subject and include the facility name, city, state, province, and country.
6. Indicate the dates of attendance for each clerkship in chronological order using the format (mm/dd/yyyy) for both start and end dates.
7. For each clerkship, indicate the total weeks or clinical hours completed.
8. The medical school official must certify the information by providing their printed name, title, and signature, along with the date.
9. Ensure that the signature does not come from a relative of the applicant, as specified, and attach any necessary delegation evidence if needed.
10. After completing all sections, be sure to save changes, and download or print the form as necessary. Remember that the completed form must be mailed directly from the medical school to the Board for acceptance.

Begin completing your CA 07A-100 L5 form online today.