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MEDICAL BOARD Licensing Program

BUSINESS, CONSUMER SERVICES, AND HOUSING AGENCY - Department of Consumer Affairs EDMUND G. BROWN JR., Governor MEDICAL BOARD OF CALIFORNIA Licensing Program 07A-100 (Revised 7/2016) 2005 Evergreen Street, Suite 1200, Sacramento, CA 95815-3831 (916) 263-2382 (800) 633-2322 FAX: (916) 263-2487 CERTIFICATE OF MEDICAL EDUCATION Check one: or Canadian MEDICAL School Graduate International MEDICAL School Graduate Type or Print Legibly APPLICANT INFORMATION MBC Use Only Applicant Information MEDICAL School Information School Code LEGAL NAME.

OF CALIFORNIA MEDICAL BOARD Licensing Program 2005 Evergreen Street, Suite 1200 Sacramento, CA 95815-5401 Phone: (916) 263-2382 Fax: (916) 263-2487 www.mbc.ca.gov

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