California medical board form l5 2012-2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your personal information in the 'Applicant Information' section. Fill in your last name, first name, middle name, date of birth, and U.S. Social Security Number clearly.
3. In the 'Medical School of Graduation' section, ensure you provide the name of your medical school and complete the form in English as required.
4. Document your clinical clerkships under 'Clinical Subject.' List one subject per line along with the facility name, city/state/province/country, and dates of attendance in chronological order.
5. For each clinical experience, indicate the weeks or weekly clinical hours spent at each facility. Ensure all entries are accurate and complete.
6. The 'Medical School Official Certification' must be completed by an authorized official from your medical school. They should print their name, title, sign, and date the form.
7. Finally, remember that this form must be mailed directly from your medical school to the Board for it to be accepted.

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