Special Activity Certificate

The holder of a special activity certificate may practice medicine and surgery or osteopathic medicine and surgery only in conjunction with the special activity, event or program for which the certificate is issued. A special activity certificate is valid for the shorter of thirty days or the duration of the special activity, program or event. The certificate may not be renewed.

Click here for eligibility requirements. Apply online at eLicense.ohio.gov. You will also need to complete a Verification of Activity form.

Please note: the Medical Board is unable to confirm receipt of supporting documents prior to an application being submitted. 

Once an application has been submitted, any documents that have been previously received will be attached to the application. Please allow the Board 10 business days to perform an initial review of your application. After that time, you may check the status of your application by logging into eLicense and navigating to your license application. Select the Options tab and the Review Status option. Any outstanding items will be listed in the ‘Comments’ section at the bottom of the page.

Criminal Offenses

Q: What must be disclosed on the application regarding arrest/criminal history?

A: If you have ever been arrested, charged, or convicted of a misdemeanor or a felony you must disclose the incident(s) on the application, regardless of whether the criminal records were subsequently sealed or expunged.  This includes serious traffic offenses such as reckless driving, driving under the influence of alcohol and/or drugs, hit and run, evading a peace officer, failure to appear, and driving under suspension. Matters in which you were diverted, deferred, pardoned, or pled nolo contendere must also be disclosed.  If you are in doubt as to how to respond to the application questions, full and honest disclosure is recommended.

Failure to provide truthful responses to the questions on the application may result in disciplinary action up to, and including, permanent denial of your application.

Explanatory Statement Disqualifying Offense List 

Disqualifying Offense List 

Initial Application Fees

Application $125.00

Transaction fee $3.50

Total due at submission $128.50