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 past 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.
- Reference Documentation - Must submit two (2) letters of reference documenting the applicant’s character from past/present Co-Instructors/Professors. The letters should be original and dated within the last six (6) months and should go into detail regarding the applicant's character and job performance.
- Professional Qualifications - Must submit documentation certifying the applicant’s professional qualifications.
- Medical School Letter - The Medical School must be accredited and are required to submit a letter to the Board indicating the applicant’s teaching appointment terms and listing the medical subjects to be taught.
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.