Part 1: To be completed by the Department

  • Internal Forms
  • Ensure the 2113 Applicant has completed the form and provided the required supporting documents.
  • Submit both the Internal Forms, 2113 Application, and required documents via email to the DGSOM Assistant Director for Visa and Licensing Office.
  • Joan Grace Cerera will return the signed Dean’s Office Support Letter and 2111 Application to the department for submission to the Medical Board of California.
    Note: It is the responsibility of the Department Coordinator to submit the application and documents to the Medical Board of California and copying Joan Grace Cerera in all correspondence

Part 2: To be completed by the Applicant

  • Medical Board of California Forms
  • Return the form with the required items to the department that will be recommending you for the 2113. DO NOT send them directly to the Medical Board or the Dean’s Office.