Downloadable Application Kits for Limited License Program Changes
Applicants for limited license program changes in Massachusetts may download any or all of the following forms for use in preparing their application.
- Do not send these forms to the Board of Registration in Medicine. All completed forms must be sent to your training program.
- Do not complete and mail these forms until you have been accepted into an accredited training program.
- Each kit has a set of instructions. Please read the instructions carefully before filling out the forms.
- Program Change Kit
- Program Change Instructions
- Program Change Checklist
- Program Change Application
- Program Change Supplement
- Evaluation Form
- State License Verification
- Authorization for Release
This information is provided by the Board of Registration in Medicine.