Application For A License To Practice Podiatric Medicine Page 2
ADVERTISEMENT
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24ALASKA STATE MEDICAL BOARD
APPLICATION FOR PODIATRIC MEDICINE LICENSE
IMPORTANT INFORMATION – PLEASE READ CAREFULLY
QUALIFICATIONS FOR LICENSURE
THRESHOLD QUALIFICATIONS FOR LICENSURE
-
Successful graduation from a school of podiatry accredited by the Council of Podiatric Medical Education
Successful completion of post-graduate training in a program accredited by the Council of Podiatric Medical
-
Education to include:
One year of internship training in podiatric medicine and
-
-
One year of podiatric surgical training
-
Successful completion of the National Boards examination or the PMLexis examination
CONTENTS OF A COMPLETE APPLICATION BY CREDENTIALS or EXAMINATION INCLUDES:
1
Application ( pages), notarized with recent passport-style photograph
2
Appropriate fees, $500 total
($200 nonrefundable application fee, $300 license fee)
You may remit a minimum of $275 (nonrefundable application fee and $75 temporary
permit fee) at the time of application so that a temporary permit may be issued. However,
the balance of $225 must be paid before the permanent license is issued. All applications
must be accompanied by the appropriate fee. Personal checks, cashier’s checks, or money
orders must be made payable to the State of Alaska. Incorrect fees will delay processing
of your application.
3
Authorization for Release of Records
4
Appropriate examination scores as required
5
Podiatric Medicine School Diploma, certified true copy of original document
6
Postgraduate Training Program Certificates, certified true copies of original documents
7
Verifications of Licensure from all licensing jurisdictions, both U.S. and International,
in which you have ever been licensed as any health care professional
8
A listing of all hospitals where you have held privileges in the five years preceding your
application in Alaska
9
Verifications of hospital privileges from all hospitals in which you have held privileges
in the five years preceding your application in Alaska
10
Clearance report from the Drug Enforcement Administration
11
Clearance report from the Federation of Podiatric Medical Boards’ Disciplinary Data Bank
12
Verification of medical school education
13
Verification(s) of postgraduate training
14
National Practitioner Data Bank report – requested by our licensing examiner
It is your responsibility to submit the proper forms to the appropriate boards, hospitals, and other agencies and to pay any fees
required by those agencies.
08-4109 (Rev. 10/15/14)
Application Information
Page 1 of 5
ADVERTISEMENT
0 votes
Related Articles
Related forms
State Form 44614 - Application For A License To Practice Veterinary Medicine Or Registration To Practice Veterinary Technology
Financial
Application For A License To Carry A Concealed Deadly Weapon - Superior Court Of The State Of Delaware
Legal
Form Mv-372 - Application For A License To Operate A Private Service Bureau Or Open A Branch Office
Legal
Related Categories
Parent category: Legal