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The MDC1 form is a crucial document for those seeking the conferral of a Doctor of Medicine (M.D.) degree from the New York State Education Department. This application is specifically tailored for individuals who have completed their medical education at a foreign medical institution that does not grant the M.D. degree but whose philosophy and curriculum are recognized as equivalent to those of U.S.-based medical schools. To meet the criteria for this application, candidates must hold a valid license to practice medicine in New York State, adhering to state laws governing medical practice. The form requires comprehensive personal information, including the applicant's Social Security number and medical license details, as well as compliance with certain ethical standards. Notably, an application fee of $300 is required, payable only by check or money order, and specific attestation statements must be signed to confirm the veracity of the application. Furthermore, applicants must respond to questions regarding any professional misconduct or legal issues that may affect their eligibility. The submission of this form, along with any necessary documents, is a step toward gaining recognition for professional qualifications and is fundamental to advancing one's medical career in New York State.

Mdc1 Example

MDC1

The University of the State of New York

THE STATE EDUCATION DEPARTMENT

M.D. Conferral

Office of the Professions

Division of Professional Licensing Services

 

www.op.nysed.gov

 

Application for Conferral of M.D. Degree

by Board of Regents

Requirements and Instructions

1.To be eligible, you must have completed a medical education program in a foreign medical school satisfactory to the department which does not grant the degree doctor of medicine (M.D.) and in which the philosophy and curriculum were equivalent, as determined by the department, in accordance with the policy of the Board of Regents, to those in programs leading to the degree of doctor of medicine (M.D.) at medical schools in the United States satisfactory to or registered by the Board of Regents and the department.

and

Hold a license to practice medicine in New York State in accordance with provisions of section 6524 or 6528 of the Education Law or their equivalent as determined by the Regents pursuant to their authority under section 6506 of the Education Law.

2.Complete this application and submit the entire form along with the required fee of $300 to the New York State Education Department at the address at the end of the form. Be sure to sign and date item 13.

Important Note: Do not send cash. The required fee of $300 must be submitted with this application. Make check or money order in U.S. funds payable to the New York State Education Department.

Department Use Only

60 $300 CD

61 $300 CD

Certificate Number

Conferral Date

Initials

1

2. Social Security Number

(Leave this blank if you do not have a U.S. Social Security Number)

2

Month

Day

Year

3. Birth Date

43. Print Name Exactly as It Appears on Your License

Last

First

Middle

54. Mailing Address (You must notify the Department promptly of any address or name changes.)

Line 1

Line 2

Line 3

City

State

 

 

Zip Code

 

 

 

 

Country/

Province

65. Telephone/E-Mail Address

Daytime phone

Area Code

Phone

E-mail Address (please print clearly)

6

6.

Name of degree granting institution where you completed your medical education: __________________________________________

______________________________________ Degree granted: ____________________ Date granted: _______ / _______ / _______

mo.dayyr.

Address: _____________________________________________________________________________________________________

City: ________________________________ State/Province: _________________________ Country: __________________________

7

7.

New York State medical license number: ________________________________________ Date issued: _______ / _______ / _______

mo.

day

yr.

New York State limited medical license number: __________________________________ Date issued: _______ / _______ / _______

mo.

day

yr.

MDC1, Page 1 of 2 (Rev. 10/08)

78.

Since you last registered, has any state other than New York instituted charges against you for professional misconduct, unprofessional conduct, incompetency or negligence, or revoked , suspended, or accepted surrender of a professional license held by you?

Yes No

89.

Since you last registered, have you ever been found guilty after trial, or pleaded guilty, no contest, or nolo contendere to a crime

 

(felony or misdemeanor) in any court?

Yes

No

109.

Since you last registered, are criminal charges pending against you in any court?

Yes

No

11

10.

Since you last registered, are charges pending against you in any jurisdiction for any sort of professional misconduct?

Yes

No

12

11.

Since you last registered, has any hospital or licensed facility restricted or terminated your professional training, employment, or privileges or have you voluntarily or involuntarily resigned or withdrawn from such association to avoid the imposition of such action due

to professional misconduct, unprofessional conduct, incompetence, or negligence?

Yes

No

NOTE: If you answer "Yes" to any questions numbered 8-12, submit a letter giving a complete detailed explanation. Include copies of any court records (conviction records), and if you possess one, a copy of the "Certificate of Relief from Disabilities" or your "Certificate of Good Conduct."

1312.

ATTESTATION

I certify that the statements made in this application and any accompanying documentation are true, complete and correct. I understand that any misrepresentation or any false or misleading information made in connection with my application may result in criminal prosecution and may be cause for disciplinary action, including the loss of my license and that the willful failure to register while continuing to practice my profession constitutes professional misconduct.

__________________________________________________________________________

_________________________________

Signature

Date

In this space

securely attach

photograph taken

within the past year.

Write signature on light portion of photograph, not across features

Date of Photo _______ / _______ / _______

Mail this form and the required $300 fee to: New York State Education Department, Office of the Professions, Division of Professional Licensing Services, Certification and Verification Unit, 89 Washington Avenue, Albany, NY 12234-1000. DO NOT

SEND CASH. Make check or money order payable in U.S. funds to the New York State Education Department

MDC1, Page 2 of 2 (Rev. 10/08)

Form Characteristics

Fact Name Description
Purpose The MDC1 form is used to apply for the conferral of an M.D. degree by the Board of Regents in New York State.
Eligibility Criteria Applicants must have completed a medical education program at a foreign institution that does not grant M.D. degrees.
License Requirement A valid New York State medical license is required, in accordance with sections 6524 or 6528 of the Education Law.
Application Fee A fee of $300 must accompany the application. Cash should not be sent.
Submission Guidelines The completed MDC1 form along with the fee must be sent to the New York State Education Department.
Social Security If the applicant has a U.S. Social Security Number, it must be included; otherwise, that section should be left blank.
Photograph Requirement A photograph taken within the past year is required, with the applicant's signature on the light portion.
Criminal Charges Disclosure Applicants must disclose any past criminal charges or professional misconduct in the application.
Governing Authority The MDC1 form is governed by the New York Education Law, specifically sections 6506, 6524, and 6528.

Guidelines on Utilizing Mdc1

Taking the time to fill out the MDC1 form accurately is crucial to ensuring your application is processed without delays. After submitting your completed form and the required payment, it will be reviewed by the New York State Education Department. Be diligent in completing each section to avoid any setbacks in your conferral process.

  1. Gather your materials, including the required $300 fee (check or money order) and a recent photograph.
  2. Provide your Social Security Number, if applicable. Leave it blank if you do not have one.
  3. Enter your Birth Date in the format Month/Day/Year.
  4. Print your Name exactly as it appears on your license, including last, first, and middle names.
  5. Fill in your Mailing Address. Notify the department promptly if your address changes.
  6. Write your Telephone and E-Mail Address, ensuring clarity in your contact information.
  7. Provide the name of the degree granting institution where you completed your medical education.
  8. Specify the Degree granted and the Date granted (in Month/Day/Year format).
  9. List the Address of the institution, including City, State/Province, and Country.
  10. Input your New York State medical license number and the Date issued.
  11. If applicable, provide your New York State limited medical license number and the Date issued.
  12. Answer questions 8 to 12 regarding any charges or restrictions related to your professional conduct. If you answer "Yes" to any, prepare a detailed explanation.
  13. Sign and date the Attestation section, certifying that all information is true and complete.
  14. Attach your recent photograph securely in the designated space and write your signature on the light portion.
  15. Mail the completed form along with your payment to the specified address at the New York State Education Department.

What You Should Know About This Form

What is the MDC1 form?

The MDC1 form is an application that individuals need to complete if they wish to obtain a Doctor of Medicine (M.D.) degree conferral by the Board of Regents in New York. This form is specifically for applicants who have finished their medical education abroad at a foreign institution that does not confer an M.D. degree. The form includes various requirements, fees, and instructions for submitting your application.

Who is eligible to apply using the MDC1 form?

Eligibility for the MDC1 form requires that you have graduated from a medical program at a foreign school that has been determined to be equivalent to M.D. programs in the United States. Additionally, you must hold a valid medical license in New York State, as per the regulations set forth in sections 6524 and 6528 of the Education Law.

What are the fees associated with the MDC1 form?

Submitting the MDC1 form involves a fee of $300. This amount must be paid when you send in your application. Remember, cash isn't accepted; you should make your payment via check or money order in U.S. funds, made out to the New York State Education Department.

What information do I need to provide on the MDC1 form?

You will need to provide personal details such as your name, mailing address, date of birth, and Social Security number if applicable. Additionally, you should include details about your medical education, such as the name and address of your institution and the degree you were granted. Don't forget your New York State medical license number and the date it was issued.

How do I submit the MDC1 form?

The completed MDC1 form, along with the required fee, should be mailed to the New York State Education Department. Make sure to address it to the Office of the Professions, Division of Professional Licensing Services, Certification and Verification Unit, located at 89 Washington Avenue, Albany, NY 12234-1000. Always double-check to ensure your form is fully completed and signed before sending it out.

Can I submit the MDC1 form electronically?

Currently, the MDC1 form must be completed and submitted via traditional mail. This process ensures that all documents and required fees are properly received and accounted for. Keep this in mind as you prepare to send your application.

What happens if I answer "Yes" to any of the misconduct questions?

If you respond "Yes" to any of the questions pertaining to professional misconduct, criminal charges, or employment restrictions, it’s mandatory to submit a detailed letter explaining the circumstances. Additionally, you should include any relevant court records or certificates that pertain to your situation. Being transparent in this matter can help maintain your application’s integrity.

What is the attestation section of the MDC1 form?

The attestation section is where you certify that all information provided in the application is complete and accurate. By signing this section, you acknowledge that any false or misleading information could lead to serious consequences, including criminal prosecution or disciplinary action. This is a crucial step in the process, underscoring the importance of honesty in your application.

Common mistakes

When filling out the MDC1 form, many applicants accidentally make mistakes that can delay their application process. One common error is failing to provide a complete mailing address. The form requires a detailed address including city, state, zip code, and country or province. Omitting any of these details can lead to confusion and may cause your application to be returned or delayed.

Another frequent mistake involves the payment section. Applicants sometimes forget to include the required fee of $300 or misinterpret the payment instructions. The form explicitly states not to send cash and that payment must be made with a check or money order in U.S. funds. Ignoring this instruction can result in processing issues.

Completing the attestation part accurately is also crucial. Some individuals might overlook signing and dating item 13, which certifies that their statements are true and complete. This signature is essential for the validity of the application. Without it, the application may be deemed incomplete and could lead to further complications.

Finally, applicants often neglect to answer all the yes/no questions on the form, especially those numbered 8 through 12. If any question is answered affirmatively, an explanatory letter must accompany the application. Failing to answer these questions correctly or at all can complicate the review process or result in a denial of the application.

Documents used along the form

The MDC1 Form is an essential document for individuals seeking conferral of their M.D. degree in New York. This form plays a critical role in the licensing process for medical professionals who completed their medical education abroad. Several other forms and documents are typically submitted alongside the MDC1 form to ensure a complete application. Below is a list of these commonly used forms.

  • Proof of Medical Education: A certificate or official transcript from the foreign medical school that confirms the completion of the medical education program. This document establishes a candidate's educational background and must be satisfactory to the New York State Education Department.
  • New York State Medical License Application: This form is also required to obtain a license to practice medicine in New York. It collects personal, educational, and professional details and is crucial for verifying qualifications.
  • Background Check Authorization Form: An authorization form that permits the New York State Education Department to conduct a background check, which may include examinations of criminal records and professional conduct.
  • Letter of Good Standing: This letter, usually issued by the medical board of the state where the applicant was previously licensed, attests to the individual's good standing and any disciplinary actions taken against them. This document reassures the New York State Department of the applicant's professional record.

Each of these forms is integral to the application process alongside the MDC1 form. Ensuring that all required documentation is submitted accurately can significantly smooth the path toward obtaining medical licensure in New York.

Similar forms

  • Application for a Medical License - Similar to the MDC1 form, this document is used to apply for licensing to practice medicine in a specific state. It requires personal and educational information, proof of qualifications, and payment of a fee.
  • Degree Verification Form - This form requests verification of medical degrees from educational institutions. It ensures that the education completed aligns with state requirements, much like the MDC1 form verifies foreign medical education compatibility.
  • Continuing Education Application - Just as the MDC1 form captures necessary qualifications for conferring a degree, this application collects information about completed continuing education credits required for license renewal.
  • Supervisory Agreement Form - Like the MDC1, this document establishes professional parameters and obligations for a licensed practitioner who will supervise a medical trainee or a medical intern.
  • Medical Malpractice Disclosure Form - This form serves a similar purpose in terms of accountability, requiring applicants to disclose any history of malpractice claims, akin to disclosing professional misconduct on the MDC1.
  • Application for Clinical Fellowship - This document requests approval for clinical training, similar in function to the MDC1 form in facilitating advancement within medical professions through formal evaluation and approval processes.
  • Change of Address Notification - While simpler in nature, this document ensures that contact information remains current, directly paralleling section 5 of the MDC1 that stresses the importance of notifying relevant authorities of any changes.

Dos and Don'ts

When filling out the MDC1 form, there are several important dos and don’ts to keep in mind. Following these guidelines can help ensure your application is processed smoothly.

  • Do read all instructions carefully before starting.
  • Do provide your Social Security Number if you have one; leave it blank if you don’t.
  • Do sign and date item 13 to validate your application.
  • Do mail the form with the required fee of $300 using a check or money order.
  • Don’t send cash. It’s not accepted and can delay your application.
  • Don’t leave any required fields blank; ensure all sections are completed.
  • Don’t forget to notify the department of any changes to your address or name.

Misconceptions

Misconceptions about the MDC1 form can lead to confusion and delays in the application process. Here are eight common misconceptions:

  • All foreign medical degrees qualify for the MDC1 form. Not all foreign medical programs are accepted. The program must meet specific criteria set by the New York State Education Department.
  • You do not need a New York medical license to apply. A valid New York State medical license is required to submit the MDC1 form.
  • Submitting cash is acceptable for the application fee. Cash should never be sent. The application fee must be a check or money order.
  • Filling out the form is optional. Completing the MDC1 form is mandatory for those seeking conferral of their M.D. degree.
  • No additional documentation is needed. If there are any issues such as misconduct charges, detailed explanation and supporting documents must be provided.
  • Signing the form is not important. The applicant must sign and date the form to validate it properly.
  • Photographs are not required. A recent photograph must be securely attached to the form as part of the application process.
  • There are no consequences for misinformation. Providing false information can lead to severe consequences, including criminal prosecution and disciplinary actions.

Key takeaways

When filling out and using the MDC1 form, keep the following key takeaways in mind:

  • Eligibility Requirements: Ensure you have completed a satisfactory medical education program from a foreign medical school, equivalent to U.S. programs.
  • License Status: Confirm that you hold a valid license to practice medicine in New York State.
  • Application Submission: Submit the application form along with a $300 fee. Cash is not accepted.
  • Signature and Date: Remember to sign and date the form in the designated area to validate your application.
  • Address Changes: Keep the Department informed of any changes to your name or mailing address promptly.
  • Disclosure of Issues: Be prepared to explain any past professional misconduct, criminal charges, or other relevant issues if applicable.

Following these straightforward steps will help you navigate the MDC1 form process more confidently.