RETIRED SENIOR VOLUNTEER

Instructions

Demographics

Regulatory Questions

Education Information

State Licensure

Certification

Declaration of Citizenship

Release

Review Page – If everything is correct, press “Next”

Submit

List all schools attended, undergraduate work other than medical school, dates attended, and degree conferred.
  
List all medical schools attended, dates, and complete addresses of institutions. Do Not list post-graduate medical education training.
  
List all post-graduate medical education training since graduation from medical school, dates, and complete addresses of institutions. DO NOT list practice experience.
  
Please note that after you click the Submit button, you cannot make changes to your application.

P.O. Box 946 / Montgomery, AL 36101-0946 / (334) 242-4116