Preventive Medicine Residency
Oregon License and Eligibility Questionnaire
(for informational purposes, not for the Oregon Board of Medical Examiners)
1. Where did you receive your accredited medical education:
2. Where did you receive your PGY training?
3. Which United States medical licensing exam(s) did you take?
4. Test score results of USMLE: Step 1:
5. What is your citizenship or immigration status?
6. Have you submitted a license application to the Oregon Board of Medical Examiners
(OBME)? (please check)
If NO, please explain:
7. Do you intend to apply for a “full” or “limited” license?
8. If you do not possess an Oregon medical license, are you aware of any reason why you
might be denied Oregon Licensure? (explain)
9. Has your medical license ever been stipulated or revoked? Has an application been