Texas Doctor's Act (HB 2038) - Provisional Medical License Application

For any technical difficulty, please reach out to support@ibnsinafoundation.org

Disclaimer: IBN SINA Foundation does not issue medical licenses. Our role is limited to preliminary assessment and guidance. Only the Texas Medical Board (TMB) can issue a provisional or full physician license.

Note: This application supports multiple Dr ACT programs. Program selection determines eligibility review and onboarding pathway.

TEXAS DOCTOR'S ACT (HB 2038) – Provisional Medical License

Insurance & Liability Notice

All participants in the Clinical Rotations Program and Volunteer Specialist Program are required to maintain their own valid professional liability (malpractice) insurance for the duration of their engagement. Dr ACT does not provide liability coverage for rotation participants or volunteers. Proof of personal liability insurance meeting applicable U.S. and facility requirements must be submitted prior to placement.

Application Form – Effective September 1, 2025

Personal Info

Education

Foreign License

Experience

Exams

Employment

Background

Review & Submit

SECTION A — PERSONAL INFORMATION

Full Name

Full name is required

Date of Birth (MM/DD/YYYY)

Valid date of birth is required

Gender

Male

Female

Other

Please select a gender

Country of Citizenship

Country of citizenship is required

Passport Number

Passport number is required

Email Address

Valid email address is required

Phone Number

Phone number is required

U.S. Address (if applicable)

Current Visa/Work Status

U.S. Citizen

Permanent Resident

H-1B

O-1

J-1

Other:

Please select a visa/work status

SECTION B — MEDICAL EDUCATION

Medical Degree

Medical degree is required

Medical School Name

Medical school name is required

Country of Medical School

Country is required

Year of Graduation

Valid graduation year is required

ECFMG Eligibility

Yes, my medical school qualifies me for ECFMG eligibility

ECFMG eligibility is required. You must be ECFMG eligible to proceed.

SECTION C — FOREIGN MEDICAL LICENSURE

Country of Current Medical License

Country is required

License Number

License number is required

Issue Date

Issue date is required

Expiry Date

Expiry date is required

Licensure Status

Active and in Good Standing

Not in Good Standing (explain):

Please select licensure status

Disciplinary History

None

Yes (provide explanation and documentation)

Please select disciplinary history

Upload Document

Please upload a document

SECTION D — POSTGRADUATE TRAINING & EXPERIENCE

Select Your Pathway

Path A — Countries Requiring Residency

Path B — Countries NOT Requiring Residency

Please select a pathway

SECTION F — EMPLOYMENT IN TEXAS

Do you have a verified job offer in Texas?

Yes

Please indicate if you have a job offer

Employer Name

Employer name is required

Facility Type

Hospital

Facility-Based Practice

Group Medical Practice

Please select facility type

Address

Address is required

Employer Contact Person

Contact person is required

Designation

Designation is required

Phone

Phone is required

Valid email is required

Application Summary

Please review all information before submitting. Make sure all details are accurate and complete.

Note: After submission, you will receive a confirmation email and the administrator will be notified.

SECTION H — CONSOLIDATED DOCUMENTS CHECKLIST

Please indicate which supporting documents are included with your application. Mark "Mandatory" as applicable and tick the status box when the document is attached.

Document	Mandatory	Status
Passport copy	Yes	File must be 2MB or smaller
Medical degree diploma	Yes	File must be 2MB or smaller
Medical school transcripts	Yes	File must be 2MB or smaller
Proof of ECFMG eligibility	Yes	File must be 2MB or smaller
Copy of foreign medical license	Yes	File must be 2MB or smaller
Good standing certificate	Yes	File must be 2MB or smaller
Disciplinary clearance letter (if applicable)	Conditional	File must be 2MB or smaller
Residency completion certificate (if applicable)	Conditional	File must be 2MB or smaller
Employment experience letters / Clinical practice verification	Yes	File must be 2MB or smaller
USMLE Step 1 score report	Yes	File must be 2MB or smaller
USMLE Step 2 score report	Yes	File must be 2MB or smaller
Texas Jurisprudence Exam proof	Yes	File must be 2MB or smaller
English proficiency certificate	Yes	File must be 2MB or smaller
Job offer letter from Texas facility	Yes	File must be 2MB or smaller
Contract (if available)	No	File must be 2MB or smaller
Criminal background check	Yes	File must be 2MB or smaller
Police clearance	Yes	File must be 2MB or smaller
Military documents (if applicable)	Conditional	File must be 2MB or smaller

SECTION I — APPLICANT ATTESTATION

I hereby certify that all information provided in this application is accurate, truthful, and complete. I understand that providing false or misleading information may result in denial, suspension, or revocation of licensure.

Applicant Signature

Signature is required

Date

Date is required

📋 Application Preview

Please review all your information carefully before submitting.

I certify that the above record is correct and all information provided is accurate and truthful.

You must certify that the information is correct before submitting

✓

Application Submitted Successfully!

Your Texas Doctor's Act Provisional Medical License application has been successfully submitted.

Application ID: TDA-2025-

✉️ Confirmation emails have been sent to you and the administrator.

Next Steps:

Check your email for confirmation and further instructions
Keep your Application ID for reference
You will be notified within 14 business days regarding the status