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Indiana Professional Licensing Agency

PLA > Professions > Medical Licensing Board of Indiana > Applications for Licensure > Temporary Medical Fellowship Permit Temporary Medical Fellowship Permit

Application for a Temporary Medical Permit (For Postgraduate Training, Teaching, or Fellowship)

Note: An individual who applies for a temporary fellowship permit is not required to take any step of  the USMLE.

Documents Required for Licensure

  1. Completed Application
  2. Photograph - passport quality photo taken within the past three (3) months.
  3. Application Fee - $100 in the form of a check or money order to the Indiana Professional Licensing Agency.
  4. (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.
  5. 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.
  6. Reference Letters - Please direct two (2) letters of reference, with original signature, dated within the last 6 months, to be submitted to document your character and professional qualifications.
  7. Valid Permit - Please submit a notarized copy of a valid permit issued by another state for participation in a postgraduate medical education or training program located in a state that has standards for postgraduate medical education and training satisfactory to the board. (Applicant must be in a postgraduate medical fellowship training program in the state that issued the permit).
  8. Supervising Physician Affidavit - Must submit a notarized affidavit that is signed by a physician licensed in Indiana; include the license number of the signing physician; physician needs to make a statement attesting that he/she will monitor the work of the physician holding the temporary fellowship permit.
  9. Hospital/Institution Certificate - The Hospital/Institution Certification (page 3 of your application) must be completed by the Hospital/Institution Chairman Department Head.

Positive Response

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.