Get Application For A Limited License To Participate In A ... - State Of Indiana

This guide provides a detailed walkthrough for completing the Application For A Limited License To Participate In A Postgraduate Training Program for Podiatric Medicine in Indiana. By following these steps, users will be able to navigate the online application process effectively.

Follow the steps to complete your application online.

1. Press the ‘Get Form’ button to access and open the application form in your browser.
2. Carefully read the instructions on the form to understand what information is required. Make sure you have all necessary documents and information at hand.
3. Fill out the applicant information section, including your name, current address, permanent address (if applicable), Social Security number, date of birth, place of birth, and email address. Ensure all information is typed or clearly printed.
4. Attach a passport-quality photograph of yourself in the designated area on the form.
5. Complete the pre-professional education section by providing details about the name of the school, location, and dates attended.
6. Indicate the Doctor of Podiatric Medicine degree issued by your school, including its name, location, and dates attended.
7. Answer the series of questions regarding any prior disciplinary actions or other relevant issues according to the form. If you respond 'Yes' to any questions, you will need to provide detailed explanations in a signed and notarized statement.
8. Sign the application affirmation to affirm the truthfulness of the provided information. Ensure to date your signature appropriately.
9. Complete the authorization for release of information section, including your signature and date.
10. Finalize the postgraduate training verification section, which needs to be filled out by the hospital or institution chairperson or department head.
11. Review your completed application to ensure all fields are filled accurately and all required attachments are included.
12. Once all information is verified, you can save your changes, download the form, or print it for submission to the Indiana Board of Podiatric Medicine.

Begin filling out your application online today to ensure a smooth process.