The applications package for the Advisory Committee on Physician Assistants must include all documents listed in the chart below. The Board reviews each application package and determines an applicant's eligibility for a license. There are two different types of forms: online application forms and printable forms. Please follow the instructions for each and include all forms in the application package in hard copy format.
Specific instructions are provided within each form below.
Application Documents
Online Application
Character Reference Form
Certification Form
Authorization for Release of Information
Character Reference Form
Certification Form
Authorization for Release of Information
Physician Assistant DMV Reciprocity Checklist
Physician Assistant Reactivation Checklist
Physician Assistant Reinstatement Checklist
Physician Assistant New Checklist
Physician Assistant Reactivation Checklist
Physician Assistant Reinstatement Checklist
Physician Assistant New Checklist
Name Change Form
Physician Assistant Delegation Forms
DC Municipal Regulations for Physician Assistant
Contact Phone:
(877) 672-2174
Contact Fax:
(202) 727-8471
Contact TTY:
711
Office Hours:
Monday to Friday 8:15 am to 4:45 pm
Service Location:
Health, Department of
GIS Address:
2201 Shannon Place SE
City:
Washington
State:
DC
Zip:
20020