PLEASE READ CAREFULLY

Items to have ready as a reference BEFORE beginning completion of this form you are a new resident/fellow at the University of MN.
Note - you cannot save an incomplete entry to finish later if you do not have all of this information:

• CV (curriculum vitae).
• Medical School Information (name, address, graduation date (past/anticipated)).
• SSN OR SIN OR Passport Number.
• ECFMG Certificate Number and certification date (International Medical School graduates - if applicable).
• Current/Future Visa Status (if applicable).
• Current or previous healthcare practitioner licensing information (if applicable).
• If you have a pre-existing University of MN ID Number and email address, please have them ready to enter.

--- I have all of the documents listed above.