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26MEDICAL LICENSES
You must be licensed by the State of Michigan before you may begin your residency or fellowship program. Please
complete the appropriate process and type or print your legal name exactly the same on all forms.
NEW DO MICHIGAN EDUCATIONAL LIMITED LICENSE
1. Michigan Educational Limited Licenses Application
Complete the State of Michigan Application for Educational Limited and Controlled Substance Licenses.
Complete the Certification of Appointment to a Michigan Training Hospital, Section I only and print your
name in the box on page 2.
If you do not have a US Social Security Number: Also submit a letter stating that you are resident of a
foreign county (sample enclosed).
Obtain a Certified Check or Money Order, payable to the STATE OF MICHIGAN for $170 US. This fee will be
reimbursed to you in August.
Return these forms and the check or money order to the Henry Ford Hospital GME Office. HFH will submit
your application to the State of Michigan – Board of Medicine.
2. Fingerprint Request Form Instructions
Follow instructions provided and have an ink fingerprint performed. There are two different forms: one to
use if you are in Michigan; another if you are out‐of‐state or country.
It is important that you do this immediately. The State of Michigan will NOT process your license application
until they receive your fingerprints and criminal background check report.
3. Certification of Internship
If you are/have completed an Internship, complete the Certification of Internship, Section I only and print
your name in the box on page 2.
Provide to your Director of Medical Education of the hospital which you are/have served your internship; ask
that they complete and it submit directly to the Michigan Department of Licensing & Regulatory Affairs,
Board of Osteopathic Medicine & Surgery, PO Box, 30670, Lansing, MI 48909.
It is important that you do this immediately. The State of Michigan will NOT process your license application
until they receive your medical school certification.
4. Medical School Certification of Medical Education
Request from your medical school, to be sent directly to Michigan Department of Licensing & Regulatory
Affairs, Board of Osteopathic Medicine & Surgery, PO Box, 30670, Lansing, MI 48909: Either, (1) final
transcripts or (2) an official letter of good standing, written not more than 90 days prior to your date of
graduation.
It is important that you do this immediately. The State of Michigan will NOT process your license application
until they receive your medical school certification.
5. Verification of Licensure in Another State
If you currently hold, or have ever held a full or permanent medical license in another state, verification of
the license status must be received directly from the other state to the State of Michigan –Board of
Medicine. Contact the Board of Medicine in the state where you hold/held a full or permanent license for
instructions; most states charge a fee.
2/15/13
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