PDF Traviss Technical Center - Polk Education Pathways 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the 'General Information' section. Enter your full name, including any degrees, and provide your spouse’s name, office address, birthdate, city, state, zip code, birthplace, phone number, fax number, and email address.
3. Proceed to the 'Education, Training and Appointments' section. List your medical school and internship details along with the duration and completion year. Include information about your general surgery residency and any fellowships.
4. In the 'Current Practice' section, indicate the percentage of your current practice dedicated to various surgical specialties. Fill in your certificate number and year of certification.
5. Complete the 'Member Sponsors' section by providing names for two sponsors who will submit letters of recommendation on your behalf.
6. Review all sections for accuracy before saving or exporting your completed application.

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