Other Information

If you have US military experience, select your anticipated status at the time of enrollment from the drop-down. Select Not a member of the military if this does not apply.

If a member of the military, select your branch of the Armed Forces from the drop-down and indicate the dates of service.

Enter your medical licensure details.

Additionally, indicate whether you have ever been the subject of any disciplinary proceedings by any state licensure agency or hospital. If yes, enter an explanation in the spaces provided.

Indicate if you are US board-certified. If you select Yes, enter details about the certification.

Indicate if you are participating in the NRMP Match and enter your NRMP ID, if applicable. 

Enter your AAMC ID and, if applicable, your National Provider Identifier.