Get De Application For Physician Training Licensure 2020-2025

This guide provides a clear and supportive approach to completing the DE Application For Physician Training Licensure online. Whether you are a resident, intern, fellow, or house physician, the following steps will help you navigate the form effectively.

Follow the steps to successfully complete your application.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Provide your identifying and contact information. Fill in your full name, other names used (if applicable), date of birth, gender, and social security number if issued. Include your personal address, home, and work contact numbers, and email.
3. Enter the institution information. Specify the name of the institution where you will be employed or trained, the department, and the mailing address for correspondence. Include your start date and select your type of employment or training (intern, resident, fellow, house physician).
4. Detail your medical education. Indicate if you completed your medical education in the U.S. If you studied abroad, you will need to specify the medical school, graduation date, and location.
5. Complete the examination and licensure history section. If you have taken relevant examinations, provide details including the location and results. If you held a license in another jurisdiction, list the details.
6. Address the disclosures section. If you answer “yes” to any of the disclosure questions, provide a complete explanation using the suggested Physician Self-Report form.
7. Complete the Criminal History Record Check Authorization form and the Delaware Child Protection Registry Consent Form. Both forms require your signature and will need to be submitted with the application.
8. Sign and notarize the application. Both you and the Director of the Training Program or Supervising Physician must sign the application in front of a notary.
9. Submit the application along with the non-refundable processing fee, required supporting documentation, and the signed forms. Ensure your application is complete to avoid rejection.
10. Finally, ensure all changes are saved. You can then download, print, or share the completed application as needed.

Begin your application process online to secure your Delaware Physician Training Licensure today.