Application for a Temporary Medical Permit (For Postgraduate Training, Teaching, or Fellowship)
Documents Required for Licensure
- Completed Application
- Photograph - passport quality photo taken within the last three (3) months.
- Application Fee - $100 in the form of a check or money order to the 'Indiana Professional Licensing Agency.'
- (If applicable) License Verification or Letter of Good Standing - from each State in which you are or have ever been licensed, certified, or registered in any regulated health profession or occupation regardless of the status. You will need to contact each state to see what they require to process the verification. It must come directly from them. We do accept digital verifications; however, the verification must come directly from the State in which you were licensed in or from Veridoc.
- Proof of Graduation - You must submit proof in one of three ways, all are listed below:
- Certificate of Completion – An original letter from the Dean of your medical/osteopathic school stating that you have completed (not expected to) all requirements for graduation and the date when the degree was awarded.
- Official Transcript – An official transcript of grades from the medical/osteopathic school, confirming medical degree. Transcripts must come directly from the school in an unopened envelope. Graduates of foreign medical schools must submit notarized copies of all subjects and grades (mark sheets). Include official translation if not in English.
- Degree – A notarized copy of your medical/osteopathic degree. Include official translation if not in English.
- Hospital/Institution Certification - The Hospital/Institution Certification (page 3 of your application) must be completed by the Hospital/Institution Chairman Department Head.
- (If applicable) ECFMG Certificate - If you are a foreign medical graduate, you must submit a notarized copy of your ECFMG (Educational Commission for Foreign Medical Graduates) certificate. If your ECFMG certificate has an expiration date you must request a permanent validation sticker from ECFMG.
If you have answered any of the questions on the application “yes” you must submit a notarized affidavit detailing the occurrence/situation, the outcome, date of occurrence, if it is a malpractice payment the amount paid in your behalf. If applicable please submit copies of all court documents and/or arrest records. Letters from attorneys or insurance companies are not accepted in lieu of your statement.