Please review the following instructions before applying.  You will need to provide dates and information of medical school, postgraduate training, locum tenens work, employment/privileges within the last 10 years, and licensure from other states - so please have this information and dates ready BEFORE you fill out the application.  Incorrect dates/information will result in a delay in the licensure process and may result in disciplinary action. 

IMPORTANT NOTICE: By submitting the application, you are certifying that the information provided is true and correct to the best of your knowledge.  You, the applicant, must be the one to fill out the Personal Questions.  Failure to provide complete and accurate information will result in an investigation that will delay the licensure process and may result in disciplinary action and/or sanctions.

Where applicable, the following documents must be uploaded with the application or by email.  As detailed below, some documents must be sent DIRECTLY from the source.  

Application Instructions

1.  Medical School Verification

(Note: if you utilize the FCVS, you do not need to separately request this verification)
List all medical schools attended and provide the following verification: 

• The Certificate of Medical Education form must be completed by your medical school and must be sent directly from your medical school to the Board.

NOTE: For approved medical school, the Board approved a decision to coincide with the Interstate Medical Licensing Compact (IMLC) accrediting bodies for acceptable/recognized medical schools.  This includes medical schools accredited by the Liaison Committee on Medical Education (ILCME), the Commission on Osteopathic College Accreditation, or a medical school listed in the International Medical Education Directory (IMED) or its equivalent.

2.  Postgraduate Training

(Note: if you utilize the FCVS, you do not need to separately request this verification).
List all postgraduate training programs attended and provide the following verification: 

• All postgraduate training programs must fill out this reference form. The form must be completed by the current program director and sent directly to the Board from the training program.

3.  Examination Scores

(Note: if you utilize the FCVS, you do not need to separately request the exam score).
Original transcripts of your licensing exam scores must be sent directly to the Board by the appropriate organization. 

• NOTE: with limited exceptions noted in North Dakota Administrative Code section 50-02-11-03.1, the Board does not allow more than three attempts to pass each step, part, or component of a licensing exam.

4.  ECFMG Verification

(Note: if you utilize the FCVS, you do not need to separately request this status report).
If applicable, an ECFMG status report must be sent directly from the ECFMG to the Board.

5.  National Practitioner Databank Report

(Note: if you utilize the FCVS, you do not need to separately request this report).
Run a “self-query” report through the National Practitioner Data Bank Report and submit to the Board.  

6.  License from other Jursidictions

Provide license numbers and statuses from any state/jurisdiction where you applied for any type of medical license (regardless of whether the license was granted or not granted, is active or inactive, temporary or permanent, restricted or unrestricted).  

7.  Employment/Privileges Verifications

In the employment/privileges section, list all your employment, hospital privileges, etc. for the past 10 years in chronological order starting with the OLDEST information first.  You will be required to fill in all gaps between dates for the last ten years. 

The Board reserves the right to seek employment verifications directly from current or former employers in line with Board policies and procedures – specifically if certain derogatory information is noted in the application (for example, revocation of privileges, arrests/convictions, malpractice history, etc.).  If such verification is required, it will be noted on your task list.   If verification is required, the facility will need to fill out and send this reference form.  The form must be completed by the facility and sent directly to the Board from the facility.

8.  Board Certifications

Provide photocopy(s) of certifications from the American Board of Medical Specialties (ABMS), American Osteopathic Association (AOA), and/or those recognized by the Royal College of Physicians and Surgeons.

9.  Photograph

Provide a recent photograph of yourself.  This photograph must be of original passport quality, no larger than wallet size, and should be a close-up front view of head and shoulders, taken no longer than 120 days prior to filing the application.

10.  Affidavit

Sign and date the Affidavit and return it via email.   We cannot process your application without this completed form.

11.  Personal References

Two personal references must fill out this personal reference form.  To qualify as a reference, the individual must be a MD/DO who has known you for over one year and can attest to your ability to safely practice.  The Board must receive the completed form DIRECTLY from the reference.   

12.  Criminal History Background Checks

You will be required to complete a criminal history background check through the following:

Complete the Criminal Record Authorization and Fingerprint Verification Forms and submit a money order in the amount of $40.00.

• Proceed to a local law enforcement office, or other private company who provides fingerprinting services, and complete TWO fingerprint cards.  You should call your local law enforcement office for times and locations if fingerprinting services are available. Please be sure to bring a photo ID. A small fee ($5-$10) may be required by the facility.  The fingerprint technician doing your prints must complete the verification form per the instructions.  Please also make sure your completed fingerprint cards and the fingerprint verification form are placed in a SEALED envelope by the fingerprint technician who took your prints with their signature written across the sealed edge of the envelope.  You should then place the sealed envelope inside another envelope addressed for mailing to the Board.  DO NOT BEND OR FOLD the fingerprint cards when mailing them to us as they will be rejected, and you will be required to be fingerprinted again. Review the following instructions for completing the fingerprint cards.  MOST offices will have fingerprint cards available on sturdy, cardstock.  However, you may also download the fingerprint cards to take with you.  Please fill in the highlighted areas.  
• Send a check or money order in the amount of $40.00 made payable to the Office of Attorney General.  
• Mail the completed criminal history record check request and fingerprint verification forms, two fingerprint cards, and a $40.00 check or money order made payable to the Office of Attorney General, to the Board office at 4204 Boulder Ridge Rd Ste 260, Bismarck, ND  58503. 

13.  Personal Data Questionnaire

As part of the application, you will be required to fill out a Personal Data Questionnaire.  This must be filled out directly by YOU as the applicant.  Please read the questions carefully.  After answering the questions, you will be required to attest and affirm that you answered the questions truthfully and accurately and recognize that inaccurate information will result in delays in processing the application, and may result in an interview, denial of licensure, or other disciplinary action. 

When in doubt – disclose! 

Provide a thorough explanation for any “yes” answer along with supporting documentation.  Failure to provide supporting documentation will result in a delay to the licensure process.

You will be asked about any past or current/pending malpractice cases.  You may utilize this form to accompany your disclosure along with other documentation. 

You will be asked whether you have ever been cited, arrested, charged, or convicted of any violation of any law, other than a minor traffic citation.  You MUST answer “yes” to this question even if the matter was dismissed, expunged, subject to a diversion or deferred prosecution program, or otherwise set aside.  If you answer “yes” to this question, it will be your responsibility to provide:

• A written explanation/narrative detailing the circumstances;
• A copy of the arrest, incident, and police report;
• Court documentation (i.e., docket, charging document, complaint, sentencing, judgements, court orders, etc.)
• If applicable, any court order assessment with diagnosis;
• If applicable, proof of compliance with probation (i.e., participation in any drug/alcohol/etc. programs; payment of fees, fines, or restitution; completion of community services; completion of restitution);
• If applicable, evidence of mitigation or rehabilitation (i.e., letters of recommendation, proof of volunteer work, completion of training or self-improvement efforts, etc.); and
• Completion of sentencing/judgement requirements.

14.  Name Change Verification

If applicable, notarized photocopy of marriage certificate or legal name change document if your name differs from that on any of your documents.

15.  Fee

As of August 1, 2023, a locum tenens application and licensure fee is $205 and an application and licensure fee of a regular license is $405.00 – payable by credit or debit card (Visa, Mastercard, or American Express).

Miscellaneous

• Do not complete the application in upper case letters.
• You have one year to complete your application.  Failure to complete will result in the application being withdrawn and you will be required to fill out a new application for licensure if you wish to continue to seek such licensure in North Dakota. 
• Once your application is received, you will have a “task list” created of further requirements, necessary/needed information, etc.  This task list is updated as information and documentation are received.  Please refer to your task list for outstanding requirements and to be kept apprised of your application status. Simply login to your account to review.
• If it has been two or more years since you have practiced clinically, you will need to submit a re-entry to practice plan as part of your application.  Please refer to the Board's Re-Entry to Practice Packet for more information.

Helpful Hints

The North Dakota Board of Medicine processes over a thousand applications for licensure every year. In each case, the Board conducts a thorough evaluation of each application. This process takes time and depends upon how quickly the applicant provides the necessary information/documentation and any derogatory information requiring closer scrutiny.

The Board will not accelerate one application at the expense of another, nor will it forego any elements of its screening/verification process.

The following suggestions are offered to help those who apply for licensure, as well as those recruiting:

• The Board cannot provide you with a timeline in which a license will be issued as it depends on YOU as the applicant providing accurate information and obtaining all required information/documentation.  The Board takes its responsibility to protect the public by licensing only qualified and competent individuals for licensure seriously and therefore will conduct a thorough examination and verification of each applicant. 
• Be cautious about making commitments on loans, practice start dates, taking specialty boards, home purchases, etc., until a license is granted. A license is not guaranteed and be cautious about not setting yourself or your colleagues up for disappointment or financial setbacks based on speculation.
• Make sure all application materials are sent to the Board as quickly as possible, in accordance with the directions set forth in the above application instructions.
• Failure to properly fill out your application will result in delays.  Please be prepared to provide the above information when you fill out your application.