When to Apply
File this application when you are a physician who is employed in an ACGME-approved institution located in Delaware and you are:
- a Resident, Intern or Fellow registered in a training program outside of Delaware who will rotate through a program in Delaware for over one month, or
- employed as a House Physician
For more information about Training licensure, see Section 4.0 of the Board’s Rules and Regulations.
Requirements for All Applicants
- Submit completed, signed and notarized Application for Physician Training Licensure. Both applicant and Director of Training Program/Supervising Physician must sign the application in front of the notary.
- Enclose the processing fee by check or money order made payable to “State of Delaware.”
- If you answer “yes” to Questions 18 - 33 in the DISCLOSURES section, you must fully explain your answer. It is suggested that you use the Physician Self-Report form for this purpose. However, if the Physician Self-Report does not fully cover your situation, you may submit a signed, notarized statement in lieu of or in addition to the Physician Self-Report.
- Complete the Criminal History Record Check Authorization form to request state and federal criminal background checks. Follow the instructions on the form to arrange to be fingerprinted. You must meet this requirement even if you recently had a criminal background check done for some other reason.
- Complete, sign and submit the Delaware Child Protection Registry Request Form to the Department of Services for Children, Youth & Their Families following the instructions on the form.
- If you have never been issued a U.S. Social Security Number (SSN), submit a Request for Exemption from Social Security Number Requirement.
Additional Requirements for Fellows and House Physicians
If you are employed as a Fellow or House Physician, the following additional requirements apply.
- Submit an 8 1/2" X 11" copy of your Postgraduate Education Training Certificate(s).
- If you are currently in training, submit a signed letter from the program director of your training institution on the institution’s letterhead. It must state that you have successfully completed your first year of training and the anticipated date you will complete your training.