Training Certificate- MD, DO, DPM

Training Certificate Application

A training certificate is intended for an individual seeking to pursue an internship, residency or clinical fellowship program in this state, who do not otherwise hold a certificate to practice medicine and surgery, osteopathic medicine and surgery, or podiatric medicine and surgery in Ohio. A training certificate is valid for one year but may be renewed annually for a maximum of five years.

A training certificate holder shall be entitled to perform such acts as may be prescribed by or incidental to the holder's internship, residency or clinical fellowship program, but the holder shall not be entitled otherwise to engage in the practice of medicine and surgery, osteopathic medicine and surgery or podiatric medicine and surgery in this state. The holder shall limit activities under the certificate to the programs of the hospitals or facilities for which the training certificate is issued. The holder shall train only under the supervision of the physicians responsible for supervision as part of the internship, residency or clinical fellowship program.

 


Eligibility


  • Be at least 18 years of age

  • Demonstrate good moral character

  • Have been accepted or appointed to participate in this state in one of the following:

    • An internship or residency program accredited by either the accreditation council for graduate medical education of the American medical association, the American Osteopathic Association, Council on Podiatric Medical Education or the American Podiatric Medical Association; or

    • A clinical fellowship program at an institution with a residency program accredited by either the accreditation council for graduate medical education of the American medical association, the American Osteopathic Association, the Council on Podiatric Medical Education or the American Podiatric Medical Association that is in a clinical field the same as or related to the clinical field of the fellowship program.

 

Application


Applicants must complete the training certificate application and enclose the application fee of $75.00.  Make check or money order payable to Treasurer, State of Ohio.  Fees are neither refundable nor transferable.

The training certificate application includes:

  • PHYSICAL DESCRIPTION  -  Attach a recent passport size COLOR photograph of yourself and complete the physical description section on page 3.

  • RESUME OF ACTIVITIES  -  Be sure to list ALL activities from medical school graduation to the present time.  Even if not working, indicate your activities and address for that time.

  • ADDITIONAL INFORMATION QUESTIONS (1 through 25)  -  You must thoroughly explain any affirmative answers.  You must also submit copies of all relevant documentation, such as court pleadings, court or agency orders and institutional correspondence and orders.

  • AFFIDAVIT AND RELEASE OF APPLICANT  -  This form must be notarized.

  • CERTIFICATION OF TRAINING PROGRAM  -  Complete the top portion of the enclosed form and forward it directly to the hospital training program director in Ohio where you will be training.

  • FORM 2 - VERIFICATION OF LICENSE  -  Complete the top portion of the enclosed form and forward it to each state (other than Ohio) and/or Canadian Province in which you hold or have held a license to practice medicine or osteopathic medicine, including a temporary license, training certificate, educational permit or other license or certificate, whether the license is current or not. The licensing agency must return the form directly to this Board. Photocopies of the form may be made.

  • EMPLOYER/TRAINING RECOMMENDATION FORM - Have your most recent employer/training program within the last five years, complete the Employer/Training Recommendation form. This form can be mailed or faxed back to the Board. If the employer/training program wants to substitute their own form letter for this form, please note that all information requested on the Medical Board form must be answered on the substitute form. * If you have changed your name due to marriage, divorce, etc. submit a copy of your name change document.

  • TO BE COMPLETED BY U.S. AND CANADIAN MEDICAL GRADUATES ONLY:

    • FORM 1 - VERIFICATION OF MEDICAL EDUCATION  -  Complete the top portion of Form 1 and forward it to the appropriate institution for completion and its return directly to the State Medical Board of Ohio.

  • TO BE COMPLETED BY INTERNATIONAL MEDICAL GRADUATES ONLY:

    • ECFMG STATUS REPORT  -  Request an ECFMG status report. The ECFMG status report may be ordered online at http://www.ecfmg.org/cvs/ or the paper forms must be downloaded from the ECFMG website (Publication Form 282A-SB and Payment Form 900)

or

  • FORM 3 - CERTIFICATION OF ECFMG  -  Complete the top portion of the enclosed form and forward it directly to the hospital in Ohio where you will be pursuing your training for completion and its return directly to this Board

or

  • VERIFICATION OF FIFTH PATHWAY PROGRAM  -  If you completed a fifth pathway program the enclosed form must be completed by your fifth pathway program. Complete top portion of the form and forward directly to your fifth pathway program for completion and its return directly to this Board.

Forms


Download Application Instructions & Checklist

MD/DO Training Certificate Application 

 

Download Application Instructions & Checklist 

DPM Training Certificate Application

 

Training Certificate Program Change Form 

 

Helpful Links


 

View the Frequently Asked Questions here.