Form Mdc1 PDF Details

Form Mdc1 is an important form that must be filled out by all business owners in Maryland. The form is used to report income, wages, and other information related to the company. Anyone who fails to file this form may face penalties, so it's important to make sure it is filled out correctly. This blog post will provide a detailed overview of Form Mdc1 and explain how to complete it accurately.

If you would like first find out how much time you need to prepare the form mdc1 and how many pages it has, here is some general data that might be helpful.

Form NameForm Mdc1
Form Length2 pages
Fillable fields0
Avg. time to fill out30 sec
Other namesmdconferral md c onferal new york form

Form Preview Example


The University of the State of New York


M.D. Conferral

Office of the Professions

Division of Professional Licensing Services


Application for Conferral of M.D. Degree

by Board of Regents

Requirements and Instructions

1.To be eligible, you must have completed a medical education program in a foreign medical school satisfactory to the department which does not grant the degree doctor of medicine (M.D.) and in which the philosophy and curriculum were equivalent, as determined by the department, in accordance with the policy of the Board of Regents, to those in programs leading to the degree of doctor of medicine (M.D.) at medical schools in the United States satisfactory to or registered by the Board of Regents and the department.


Hold a license to practice medicine in New York State in accordance with provisions of section 6524 or 6528 of the Education Law or their equivalent as determined by the Regents pursuant to their authority under section 6506 of the Education Law.

2.Complete this application and submit the entire form along with the required fee of $300 to the New York State Education Department at the address at the end of the form. Be sure to sign and date item 13.

Important Note: Do not send cash. The required fee of $300 must be submitted with this application. Make check or money order in U.S. funds payable to the New York State Education Department.

Department Use Only

60 $300 CD

61 $300 CD

Certificate Number

Conferral Date



2. Social Security Number

(Leave this blank if you do not have a U.S. Social Security Number)





3. Birth Date

43. Print Name Exactly as It Appears on Your License




54. Mailing Address (You must notify the Department promptly of any address or name changes.)

Line 1

Line 2

Line 3





Zip Code







65. Telephone/E-Mail Address

Daytime phone

Area Code


E-mail Address (please print clearly)



Name of degree granting institution where you completed your medical education: __________________________________________

______________________________________ Degree granted: ____________________ Date granted: _______ / _______ / _______


Address: _____________________________________________________________________________________________________

City: ________________________________ State/Province: _________________________ Country: __________________________



New York State medical license number: ________________________________________ Date issued: _______ / _______ / _______




New York State limited medical license number: __________________________________ Date issued: _______ / _______ / _______




MDC1, Page 1 of 2 (Rev. 10/08)


Since you last registered, has any state other than New York instituted charges against you for professional misconduct, unprofessional conduct, incompetency or negligence, or revoked , suspended, or accepted surrender of a professional license held by you?

Yes No


Since you last registered, have you ever been found guilty after trial, or pleaded guilty, no contest, or nolo contendere to a crime


(felony or misdemeanor) in any court?




Since you last registered, are criminal charges pending against you in any court?





Since you last registered, are charges pending against you in any jurisdiction for any sort of professional misconduct?





Since you last registered, has any hospital or licensed facility restricted or terminated your professional training, employment, or privileges or have you voluntarily or involuntarily resigned or withdrawn from such association to avoid the imposition of such action due

to professional misconduct, unprofessional conduct, incompetence, or negligence?



NOTE: If you answer "Yes" to any questions numbered 8-12, submit a letter giving a complete detailed explanation. Include copies of any court records (conviction records), and if you possess one, a copy of the "Certificate of Relief from Disabilities" or your "Certificate of Good Conduct."



I certify that the statements made in this application and any accompanying documentation are true, complete and correct. I understand that any misrepresentation or any false or misleading information made in connection with my application may result in criminal prosecution and may be cause for disciplinary action, including the loss of my license and that the willful failure to register while continuing to practice my profession constitutes professional misconduct.





In this space

securely attach

photograph taken

within the past year.

Write signature on light portion of photograph, not across features

Date of Photo _______ / _______ / _______

Mail this form and the required $300 fee to: New York State Education Department, Office of the Professions, Division of Professional Licensing Services, Certification and Verification Unit, 89 Washington Avenue, Albany, NY 12234-1000. DO NOT

SEND CASH. Make check or money order payable in U.S. funds to the New York State Education Department

MDC1, Page 2 of 2 (Rev. 10/08)

How to Edit Form Mdc1 Online for Free

The procedure of filling in the Form Mdc1 is actually quick. We made sure our PDF tool is easy to understand and helps fill out any PDF in a short time. Explore a couple of steps you'll have to follow:

Step 1: Select the button "Get Form Here" on the site and press it.

Step 2: So you should be on your document edit page. You'll be able to add, change, highlight, check, cross, include or remove areas or words.

Provide the information requested by the platform to complete the file.

Form Mdc1 empty fields to complete

Write the requested details in the Mailing Address You must notify, Line, Line, Line, City, State Country Province, Zip Code, Name of degree granting, Degree granted Date granted, Address, mo day yr, City StateProvince Country, New York State medical license, mo day yr, and New York State limited medical box.

Filling out Form Mdc1 stage 2

Note any particulars you need inside the field Since you last registered have, felony or misdemeanor in any court, Since you last registered are, cid Yes cid No, cid Yes cid No, Since you last registered are, Since you last registered has, privileges or have you voluntarily, NOTE If you answer Yes to any, ATTESTATION, I certify that the statements made, Signature, and Date.

stage 3 to filling out Form Mdc1

Describe the rights and responsibilities of the sides in the space Date of Photo, Mail this form and the required, and MDC Page of Rev.

Entering details in Form Mdc1 stage 4

Step 3: Press the Done button to save your document. Then it is readily available for upload to your electronic device.

Step 4: Be sure to stay away from forthcoming challenges by generating a minimum of a pair of duplicates of the document.

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