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This form is intended to gather updated contact information for families to maintain the PTL Directory.
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How to fill out ptl directory information form

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How to fill out PTL Directory Information Form

01
Gather necessary information about your organization, including the name, address, and contact details.
02
Fill in the name of the primary contact person responsible for the directory information.
03
Provide all relevant phone numbers and email addresses for easy communication.
04
Include details of additional personnel if applicable, ensuring to list their roles and contact information.
05
Review the completed form for accuracy and completeness.
06
Submit the form via the specified method (email, online submission, etc.) outlined in the instructions.

Who needs PTL Directory Information Form?

01
Any organization or entity that wants to be listed in the PTL directory or needs to update their existing directory information.
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An applicant may apply for a PTL if they have graduated from a Board-approved medical school (Business and Professions Code (BPC) section 2084), passed all required examinations, and will be enrolling or are enrolled in a California ACGME-accredited residency program.
Follow These Steps Apply Online. Click “Apply Now” to visit the CCC Application page to submit your application and connect with a recruiter. Information Session. Attend our online information session to learn program details and opportunities. Interview. Assignment.
A Postgraduate Training License is issued to an individual who has graduated from an approved medical school, passed all required examinations, and is enrolled in a Board-approved California residency program.
Postgraduate Training License: $674.00 application fee. Transition from PTL to Physician and Surgeon's License: $600.50 reduced license fee.
To apply online, you must complete the following using our BreEZe online services system: Answer the application questions. Pay all required fees. Attach copy of completed Request for Live Scan Service for electronic fingerprints, if applicable.

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The PTL Directory Information Form is a form used to collect and report directory information for persons associated with a specific program or organization. It helps ensure compliance with regulatory requirements.
Individuals or organizations that are part of a program or service that requires reporting of directory information are required to file the PTL Directory Information Form.
To fill out the PTL Directory Information Form, complete all required sections accurately, providing details such as name, contact information, and any other relevant information as instructed in the guidelines.
The purpose of the PTL Directory Information Form is to gather necessary information to maintain updated records, ensure compliance with regulations, and facilitate communication within the organization or program.
Information that must be reported on the PTL Directory Information Form typically includes the individual's or entity's name, address, contact details, affiliation, and any other information specified by the governing regulations.
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