Physician Associate Application Requirements and Instructions

Completing the Application

Omissions or false, misleading or deceptive information provided in applying for a license in Oregon is grounds for a $195 fine and further disciplinary action, including denial of your application.
Complete the application yourself. Do not delegate this important task to someone else. If the information provided is incomplete or incorrect, it will delay licensure.
Take your time and read all instructions carefully. If you have questions, contact us to assist you.
Documents submitted to the Board will not be returned to you. Keep copies of all materials submitted for your own reference.
Applications are valid for one year from the date first begun.
Apply for the appropriate type and status of license. See License Definitions page or contact us if you have questions.
Complete the online application using your full, legal name as it appears on birth, marriage, naturalization, or name change documents.
Account for all periods of time since you graduated from your physician associate training program to the present date.
Provide full details, dates, complete names and addresses where requested.

The Application Process

To speed the process, submit the application and fee before collecting the required documents. Licensing staff will identify the requirements specific to your application and may be able to gather some of the documents on your behalf.
Use the Board’s Online Status Report to help you keep track of what materials the Board has received and what is still needed to complete your license application.
Select only one person (such as you or a recruiting agency) to follow the processing of your application. This minimizes contacts to the Board and speeds the process.
Notify the Board immediately if your address or phone number changes.
If your application does not meet licensure requirements or demonstrates an area of concern, the application may require review by the Physician Associate Committee with approval of licensure by the Board.
Once your application file is complete, you will be notified to log in online to complete the initial registration process and pay the required registration fees.

Licensure

Licenses are usually issued within one week after completion of the initial registration process.
When your license is granted, you will receive a certificate of registration, a wallet license card and a formal engrossed license.
Once granted, a license can be verified immediately through the Board's license verification webpage.

Documentation Required

Size of Documents: Documents submitted must be legible, no larger than 8 1/2 x 11 inches, and no smaller than 5 x 7 inches. If the original document is larger or smaller, please have the copy reduced or enlarged to 8 1/2 x 11 inches to show all wording, dates and signatures.

Copies of Original Documents: Do not submit original documents. They will not be returned to you. Copies do not need to be notarized and must be legible.

Official Translations: If any of your documents are in a foreign language, the Board requires a copy of the original document and an official, word-for-word translation. Acceptable translators include:

An employee of a professional translating company,
A member of the American Translation Association, or
A faculty member of the modern languages or linguistics department of a United States college or university.

The translation must be on official letterhead and bear the translator's certification seal. Translations will not be returned to you. All information appearing on the document must also appear on the translation each time it appears on the original document. This includes pre-printed information, such as the letterhead of a university, titles, etc. The translation must be attached to the copy of the document being translated.

Items to be Sent From You, the Applicant

Most of these items should be submitted through the Secure Upload Portal. You may contact us at licensing@omb.oregon.gov, by fax 971-673-2670 or by postal mail.

Birth Certificate: Provide a copy of official birth certificate or birth record. Hospital birth certificates are not acceptable. Your complete, legal name, including Jr., II, III, initial only, or no middle name, will be shown on your formal license, and all licensees must pursue their profession under their own name as it appears on the license. A copy of your passport, driver's license, etc., does not meet this requirement and cannot be accepted in lieu of the required birth certificate.

Name Change (due to marriage, divorce, adoption, court order): If you have been known by names other than that exactly on your birth certificate, provide a copy of the legal documentation (marriage certificate, divorce decree, adoption papers, or court order).

Naturalization: It is a violation of law to copy a naturalization document. Instead, please complete the naturalization form provided by the Board with the number, date and place of naturalization. This form must be notarized and is available here.

Photograph: Provide a close-up passport quality photograph, front view, head and shoulders (not profile) taken within 90 days preceding the filing of the application.

Diploma: Provide a copy of your diploma showing graduation from a physician associate training program.

Fingerprints: Applicants must provide fingerprints in order for the Board to conduct a state and federal criminal records check. All fingerprints are processed through the Oregon State Police (OSP) and the Federal Bureau of Investigation (FBI). For more information, visit the Fingerprint Requirements page.

Medical Practice Act Open-Book Examination: The required MPA examination and open-book materials are available here.

The Board may require other documentation or explanatory statements.

Items to be Sent Directly From the Primary Source

Fees charged by any other agencies to provide verification to the Board are your responsibility.

The following items must be:

Fully completed with dates in month/day/year format.
Currently dated.
On letterhead, computer-generated form, or Board-provided form.
Mailed in an institution envelope. Do NOT provide your own envelope.
Faxed or e-mailed responses are not accepted.

Education Verification: Send the Verification of Medical Education form to the dean, administrator, or program director of your PA training program. The form must be completed fully, showing dates of attendance, exact date of graduation and a statement about your educational performance. The Board will return all incomplete forms to the PA program. The Board will not accept verification of education if it is received prior to your graduation. An official of the program must sign the form.

Employment Verification(s): Send the Verification of Health Related Employment form to an official at each place of employment where you practiced any health related profession (including non-clinical work) during the last five (5) years. The form must include complete beginning and ending dates of employment and an evaluation of overall performance. Verifications of employment/practice from where you are currently employed or practicing that are dated more than six (6) months prior to the receipt of your application to the Board must be re-submitted with a current verification. Only employment verifications for the past five (5) years are required unless you are advised otherwise by the Board.

License Verification(s): Send the Verification of Licensure form to an official of the board in each state, province, or country where you have ever been licensed in any health related profession, even if you have never practiced there or if your license has lapsed there. This form or a letter must show license number, date issued, grades if applicable, disciplinary actions (past and present), and current status. Do not request a verification of licensure of a temporary license issued for the completion of a training program unless informed otherwise by the Board. You may be able to request verification of some other United States licenses through VeriDoc's online License Verification System.

NCCPA Certification Verification and Exam History Form: Submit the form directly to the NCCPA at the address listed on the form. The NCCPA will provide the Board with written confirmation of your exam history, scores, certificate number and current certification status with the NCCPA. If you have not yet taken the NCCPA examination and you have completed all other requirements for the PA application, you may be eligible for a Limited License, Pending Examination.

Personal History Questions

If you answer "YES" to any personal history question, please furnish details and request source documents as indicated here.

The Board may require other documentation or explanatory statements.