INSTRUCTIONS: ALABAMA APPLICATION FOR LICENSURE OF PHYSICIAN ASSISTANT

As part of the application to be licensed as a physician assistant in Alabama, the form discussed in this article should be filed. This document can be obtained from the website maintained by the Alabama Board of Medical Examiners.

Alabama Application For Licensure Of Physician Assistant Step 1: Section I concerns identifying information. Enter your name in full on the first blank line.

Alabama Application For Licensure Of Physician Assistant Step 2: Enter your home street address on the second blank line.

Alabama Application For Licensure Of Physician Assistant Step 3: Enter your city on the third blank line.

Alabama Application For Licensure Of Physician Assistant Step 4: Enter your state on the fourth blank line.

Alabama Application For Licensure Of Physician Assistant Step 5: Enter your zip code on the fifth blank line.

Alabama Application For Licensure Of Physician Assistant Step 6: Enter your place of birth on the sixth blank line.

Alabama Application For Licensure Of Physician Assistant Step 7: Enter your date of birth on the seventh blank line.

Alabama Application For Licensure Of Physician Assistant Step 8: Enter your sex on the eighth blank line.

Alabama Application For Licensure Of Physician Assistant Step 9: Enter your Social Security number on the ninth blank line.

Alabama Application For Licensure Of Physician Assistant Step 10: Enter your home telephone number, including the area code, on the tenth blank line.

Alabama Application For Licensure Of Physician Assistant Step 11: Section II contains 20 questions that must be answered by checking "Yes" or "No" as appropriate. If you answer "Yes" to any of them, you must attach a detailed explanation or the document requested.

Alabama Application For Licensure Of Physician Assistant Step 12: Section III requires you to document your education since graduating from high school. Enter the beginning and ending dates of your attendance in the first column, the name of each school in the second column, and the school's address in the third column.

Alabama Application For Licensure Of Physician Assistant Step 13: Section IV requires you to document your work activities since graduating from high school.

Alabama Application For Licensure Of Physician Assistant Step 14: In section V, list all places you have been certified, registered or licensed as a physician assistant. Sign and date Section VI before a notary public.