• CEX are now done through MedHub, you may self initiate one (Prelims must contact Jefferson to queue up this evaluation).
  • Preceptor & Resident Self-Evaluation
  • Continuity Clinic forms
  • M&M conferences are attendance based. You must attend 2 per year, there is no form requirement for M&Ms
  • Out-of-State Elective Request Form
  • Please submit the Out of State Elective Request form to the Housestaff office. 
  • PC Research Approval Form
  • Preceptorship or Special Rotations Request Form
  • Research Approval Form
  • Request for Travel Funds Form  - If a Resident has been invited to present at a meeting or conference, it is expected that a research grant of the resident's faculty sponsor will cover the resident's expenses. The next source of funding is a grant of $1500 from the GME Educational Fund allowance. To receive this funding, please provide a copy of the invitation to present along with this form to In order to be reimbursed, travel arrangements must be made through our office. 
    • Airfare MUST be booked through Jefferson per procurement policy.
    • Please note that as of June 12, 2020 there is a system wide travel ban until January 2021. Amount of funding from GME is subject to change at this time. This information will be updated as soon as it is available.



  • DORA L3 R3 Training Verification 17-18.pdf - Please fill out SECTION ONE of this form and submit hard copy to Jennifer Weber in the Housestaff office for completion. A request for proof of malpractice insurance will be sent on your behalf. 
  • DORA (L6) Practice History​ - This form is prefilled for you.  Print, sign and add to your application. 

Please visit​ for more information on how to apply for the USMLE Step 3 exam. 

The Certification of Identity form is the only form now needed
The application process to sign up and take step 3 has changed:
“To apply for the Step 3 all physicians are required to create an account, complete the online application, and pay the fees. Once the application is submitted, all that is needed to complete the Step 3 application is the Certification of Identity form (
[NOTE: The Certification of Post Graduate Training form is no longer needed.]
If you are not contacted about your application within ten business days, contact the FSMB office ( to determine your application status. They will only provide the status information to the you, the physician, and not a third party.  Please submit USMLE Certificate of Identity form (hard copies) to Mary Meadows or Nicole Goodwin in the Housestaff office to notarize. ( example copy)