Renew and Terminate Special Permit

Notice of Separation Under Business and Professions Code Sections 2111, 2113, and 2168

Request for Renewal Under Business and Professions Code Sections 2111 and 2113

 Steps:

• Please send completed form/s to Joan Grace Cerera. She will then obtain the Vice Dean for Faculty's signature.
• The signed form/s will be returned to the department for submission to the Medical Board of California.
• For Renewal Application: Submit signed form and and other required documents, along with a check made out to the Medical Board of California.
• Proof of completed Continuing Medical Education (CME) (Questions regarding hours or categories, see "Continuing Medical Education Requirements for Physicians Licensed by the California State Board of Medical Quality Assurance")