GME Division of Medical Education
Graduate
Medical Education

TRAINING REGISTRATION OF MEDICAL CORPS PERSONNEL IN NON-FEDERAL FACILITIES
(PER SECTION 718, BUSINESS AND PROFESSIONS CODE)

The following trainee(s) will be receiving clinical training, per Section 718 of the Business and Professions Code, at the following non-federal training sites.
Rank Name Branch of Service DOB Non-Federal Facility
where training will occur		 Specialty Dates of Training
Name/Rank:
 Stationed Federal Facility:
Title:
 Address:
Branch of Service:
 City/State/Zip:
SIGNATURE:
 Date:
 		 Telephone Number:

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