CERTIFICATION OF APPOINTMENT TO A MICHIGAN ... 2026

1. Click ‘Get Form’ to open the CERTIFICATION OF APPOINTMENT TO A MICHIGAN TRAINING HOSPITAL in the editor.
2. Begin by filling out the Applicant Information section. Enter the applicant’s first name, last name, middle name, address, city, state, date of birth (MM/DD/YYYY), zip code, email address, and telephone number.
3. Next, move to the section designated for completion by the Director of Medical Education. Fill in the name and address of the training hospital along with its city, state, and zip code.
4. If applicable, include the ACGME Program Number. Then proceed to certify the appointment by providing details about the clinical area program name and its start and end dates.
5. Indicate whether this is an active postgraduate training program accredited by ACGME by selecting 'Yes' or 'No'.
6. Finally, ensure that the Director of Medical Education signs and prints their name along with the date. If there is no hospital seal, indicate that as well.

Start using our platform today to easily complete your certification form online for free!