Applications/Forms

The following forms are in Adobe Acrobat Reader.  Click the following link to download a free version of Adobe Acrobat Reader.

The following document will assist applicants applying for medical/osteopathic licensure if the applicant discloses prior history or current matters relating to Kentucky licensure.  This list is for informational purposes and additional information can be requested by the Board depending on individual circumstances. 

• Special Licensure Item Documentation Requirements (PDF 28KB)

• Residency Rotation Exemption Registration (PDF 13KB)
• Institutional Practice Limited License/Residency Training License Application (PDF 141KB)  
• Residency Form - Changing IP to R License (PDF 17KB )
  
• Faculty License Information (PDF 12KB)
• Faculty License Application (PDF 131KB)
  
• Fellowship Training License Application  (PDF 169KB)

According to KRS 311.560, section (2)(e), Prohibition against practice of medicine without a license-Exceptions:  “Persons who are nonresidents of Kentucky and licensed to practice medicine or osteopathy in their states of residence, and are providing medical services as a charitable health care provider in Kentucky through a nonprofit, all-volunteer sponsoring organization as provided for under KRS 216.940 to 216.945, after confirming to the board that their licenses are currently in good standing in their states of residence and having been issued a written waiver by the board to provide these services during the specific period stated in the written waiver.”