Application Form Letter Of Eligibility Or Long-Term Clerkship Certificate - New York State Education Dept.

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THE STATE EDUCATION DEPARTMENT / THE UNIVERSITY OF THE STATE OF NEW YORK / ALBANY, NY
12234
State Board for Medicine
89 Washington Avenue
West Wing – 3
Floor, Albany, NY 12234
nd
Tel. 518-474-3817, Ext. 560 Fax 518-486-4846
E-mail:mpressle@mail.nysed.gov
Dear Applicant:
Section 60.2(d) of the Regulations of the Commissioner of Education specifies that students enrolled in programs of medical
education not registered by the Department or found to be the equivalent of such programs may serve in clinical clerkships in teaching
hospitals in New York State for a period not to exceed 12 weeks during two academic years if such students do not met the
requirements of the Commissioner’s Regulations to engage in clerkships of more than 12 weeks.
In New York State, as provided by law, persons performing clinical clerkships are considered to be engaged in the practice of
medicine. Section 6526(8) of the Education Law provides that “Any medical student who is performing a clinical clerkship or similar
function in a hospital and who is matriculated in a medical school which meets standards satisfactory to the Department, provided
such practice is limited to such clerkship or similar function in such hospital”, may practice medicine within the State without a
license.
In order to meet the requirements of Section 6526(8) of the Education Law and Section 60.2(d) of the Regulations of the
Commissioner of Education, a student seeking to engage in clerkships for a period not to exceed 12 weeks must secure a letter of
eligibility from the State Education Department. Students requesting a letter of eligibility must specify: (1) the teaching hospital in
which the clerkship(s) has been arranged; (2) the specialty area of the proposed clerkship(s); (3) the inclusive dates of the proposed
clerkship(s); and (4) request a letter from the hospital to be sent directly to this office confirming that the applicant has been accepted
for the clerkship. Each student must also request the medical school in which he/she is enrolled to forward to the address above a
statement of the student’s matriculation status. The letter must indicate: (1) you are currently enrolled in good standing; (2) your date
of graduation; (3) you have been authorized to perform clerkships in New York State; (4) the dates for which you are authorized to
perform clerkships in New York State; (5) academic credit will be granted for the clerkship(s) and (6) teaching hospital in which the
clerkship(s) will be performed. Also, documentation must be provided indicating that the applicant has completed the
mandated infection control course ( )
In addition, each applicant must provide the following information concerning clerkships which have been completed in New
York State prior to the present application: (1) name of hospital or other facility in which clerkship(s) was performed; (2) the
inclusive dates; (3) the specialty area of the clerkship(s); and (4) the name(s) of the supervising physician(s). (Note: If no previous
clerkships have been performed in New York State, please indicate.)
A fee of $30 USD is required for each letter of eligibility to engage in a clerkship in a specific teaching hospital, regardless of
the number of clerkships to be performed. Since a separate letter is required for each hospital, the $30USD fee must be submitted for
each letter. Checks or money orders must be drawn on a US bank in US currency. The department does not accept cash or traveler’s
checks.
All application materials, i.e., your application form, letter from medical school and verification from teaching hospital,
should be received in this office no earlier than four months prior to the anticipated date of the start of your clerkship.
Please note that a letter of eligibility issued by the State Education Department does not obligate any teaching hospital to
accept medical students in clinical clerkships. Any medical school or teaching hospital may impose standards for admission to clinical
clerkships, which exceeds the standards set forth in the Commissioner’s Regulations.
Sincerely,
Suzanne Sullivan
Interim Executive Secretary

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