Get Application For Physician Training Licensure - Division Of Professional ...

Completing the Application for Physician Training Licensure is an essential step for physicians who wish to begin training in Delaware. This guide offers comprehensive, step-by-step instructions to help you navigate the online application process efficiently and accurately.

Follow the steps to complete your application with ease.

1. Press the ‘Get Form’ button to retrieve the application form and open it in your editing interface.
2. Fill in your identifying and contact information. Ensure that your full name, other names used, date of birth, gender, and social security number are accurately recorded.
3. Complete the institution information section by entering the name and address of the Delaware institution where you will be employed or trained, along with your employment or training start date.
4. Indicate your type of employment or training by checking the appropriate box: Intern, Resident, Fellow, or House Physician.
5. Provide details about your medical education, including the name, graduation date, and location of your medical school.
6. If applicable, detail your post-graduate training by listing institutions, locations, dates of training, and specialty information.
7. Fill out the examination and licensure history. Indicate if you have taken examinations and provide relevant details. If you have held licenses in other jurisdictions, list them accordingly.
8. Carefully answer the disclosures section. If you answer 'yes' to any questions, be prepared to provide explanations, possibly using the Physician Self-Report form.
9. Complete the duty to report section, acknowledging your understanding of mandatory reporting obligations.
10. Review the affidavit of applicant section, sign it, and date it. Ensure that your application is fully completed, and that you have included any required documents and payment.
11. Finally, save your changes, and follow the prompts to download, print, or share the completed application as needed.

Begin your application process online today and ensure you meet all necessary requirements for licensure.