Application & Instructions for Initial Licensure - Fellowship Training Permit

Log in to LaMED DashBoard to begin a new online initial application, complete a previously started (and saved) online initial application or to check the status of your completed online initial application. (ONLINE NOT AVAILABLE AT THIS TIME)

To access a paper application, click HERE for (available for a limited time)

The items listed below MUST be completed and mailed to the LSBME as part of the initial application process.

Oath or Affirmation
This form must be notarized.  All yes answers must be accompanied by a sworn affidavit.  A sworn affidavit is an explanation (in applicant’s own words) that must be typed and notarized.  Note: If criminal history is found that you did not disclose, you will be required to submit a new Oath or Affirmation, a notarized affidavit as to why you did not disclose the information and a new processing fee equal to the initial licensure fee.  It is important that you answer question 3 accurately and truthfully. Do not take the advice of friends, lawyer, etc.

Third Party Authorization
This form must be notarized.  It authorizes LSBME to obtain information concerning the applicant from third parties.

Certificate of Dean/Registrar
Complete Section 1 as directed. Mail to professional school/university for completion of Section 2. The school/university must mail the completed form directly to LSBME.

Background Check
LSBME conducts background checks as part of the application process.  Instructions and forms can be downloaded from our website or materials can be requested by:

  • Mail: LSBME, Attn: CBC, 630 Camp Street, New Orleans, LA 70130

  • E-Mail: lsbmecbc@lsbme.la.gov

  • Phone: (504) 568-6820

The board may, in its discretion, issue a temporary permit for the purpose of participating in unaccredited postgraduate fellowship training, at a minimum level of postgraduate year four (PGY-4), that is conducted by a Louisiana medical school or major teaching hospital, as defined herein, provided such school or major teaching hospital sponsors a fully accredited ACGME residency training program in the same specialty in which the fellowship training is offered.

QUALIFICATIONS FOR PERMIT

1.    shall:

a.    have completed a residency training program accredited by the ACGME, AOA or the Commission on Dental Accreditation (CODA) of the American Dental Association in the same specialty as the fellowship; and

b.    possess all of the qualifications for licensing prescribed by §311A.1-6 of these rules;

2.    present, or cause to be presented, to the board:

a.    a completed application in a manner specified by the board, together with the fees prescribed by Chapter 1 of these rules;

b.    satisfactory documentation that the applicant possesses the qualifications required by this Section; and

c.    a letter from the program director under whom he or she will be serving in the fellowship, describing the capacity in which the applicant will be serving and the inclusive dates of such service.

3.     Possess a standard Educational Council for Foreign Medical Graduates (ECFMG) certificate (if applicable)

4.     Certified Examination Score Report

ADDITIONAL REQUIREMENTS

Certified Birth Certificate - The applicant must submit either a certified birth certificate (a certified document can only be obtained from the issuing agency and must bear the official seal or stamp and signature of an authorized representative) or an original passport (expired passports are acceptable).  The certified birth certificate becomes a permanent part of the applicant’s file and is not returned.  If the applicant submits a passport, the applicant must include a written explanation of the reason the birth certificate is not available.

Valid Visa - Applicants who are not native-born citizens of the United States must show proof of legal entry into the United States to work and reside by presenting either:

  • An original certificate of Naturalization

  • Certified birth certificate establishing birth to U.S. citizens traveling abroad

  • Valid Visa issued by the department of Immigration and Naturalization (INS).  (Acceptable visas – J-1, H-1B, Immigrant)

FEES

Fee must be paid via credit/debit card (Visa, MasterCard or Discover only) if applying online.
Fee must be paid via Personal check/money order if sending in a paper application.
​Fee is non-refundable.
Licensure- $100.00

COMMUNICATION WITH THE BOARD

Mailing Address - LSBME, 630 Camp Street, New Orleans, LA 70130
Questions - Contact our licensing department at licensing@lsbme.la.gov. To find the analyst directly assigned to your application, click on Contact Us.