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    What You Need for Application

    US/Canada

      Medical Student Resident Fellow Practicing Psychiatrist / Retired / Semi-Retired
    Work or Home address (this address used will be used as your district branch affiliation unless you are a Medical Student, Resident or Fellow) X X X X
    Medical School institution, start & end dates (mm/yyyy) X X X X
    Residency institution, start & end dates (mm/yyyy)   X X X
    Fellowship institution, start & end dates (mm/yyyy), if applicable     X X
    Current state/province psychiatry license information       X
    Program director/coordinator name and email address   X X  

    International

      Medical Student Resident Fellow Practicing Psychiatrist / Retired
    Work or Home address (this address used will be used as your district branch affiliation unless you are a Medical Student, Resident or Fellow) X X X X
    Medical School institution, start & end dates (mm/yyyy) X X X X
    Residency institution, start & end dates (mm/yyyy)   X X X
    Fellowship institution, start & end dates (mm/yyyy), if applicable     X X
    A copy of your current psychiatry license from the country you live and work, or similar, to upload       X
    Official letter (PDF preferred) from current institution verifying enrollment, start and projected end dates to upload   X X  

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