A limited license is issued to physicians enrolled in post-graduate training programs in health care facilities. This information applies only to renewals within the same training program
Fee for Renewal of a Limited License: $100.00
For a description of license requirements and fees, see Licensing Fees and General Information.
Application Kit for Limited License Renewal
Applicants should download or print the Application Kit—it contains all the necessary documents.
- 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.
- The kit has a set of instructions. Please read the instructions carefully before filling out the forms.
Additional Resources for
Application Documents
The application documents are also available in Word format. IF YOU CHOOSE NOT TO USE THE KIT, THEN YOU SHOULD DOWNLOAD OR PRINT THE DOCUMENTS BELOW. ALL RELEVANT FORMS MUST BE SUBMITTED.
Additional Resources for
Open DOCX file, 49.05 KB, for
Limited Renewal Instructions
(DOCX 49.05 KB)
Open DOCX file, 46.94 KB, for
Limited Renewal Checklist
(DOCX 46.94 KB)
Open DOCX file, 48.48 KB, for
Limited Renewal Application
(DOCX 48.48 KB)
Open DOCX file, 31.83 KB, for
Supervisory Evaluation Form
(DOCX 31.83 KB)