Michigan lara 2026

1. Click ‘Get Form’ to open the michigan lara form in our editor.
2. Begin by filling out the Applicant Information section. Enter the applicant’s first name, middle name, last 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 Medical Director or Superintendent of the training hospital. Fill in the name and address of the hospital or institution along with its state, city, and zip code.
4. If applicable, include the AOA or ACGME Program Approval Number in the designated field.
5. In the Certification and Signature section, certify that the applicant has been appointed to a training program by entering the program name and start/end dates.
6. Finally, ensure that the Medical Director or Superintendent signs and prints their name along with the date. If there is no seal from the academic institution, indicate this as required.

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