The following information must be submitted in this order to the Maryland Department of Health, Office of Workforce Development, 201 W. Preston Street, 4th Floor Baltimore, Maryland 21201.
The Review File number and the J-1 physician’s last name must be typed on the lower right hand corner of every page. Please submit an electronic copy to mdh.providerworkforceprograms@maryland.gov along with the hard copy original/copy by mail.
- Cover Letter from the employer wishing to hire the physician for three years. (See J-1 Visa Waiver Policy, Section F, 1. for details.)
- HPSA/MUA evidence documents (as applicable).
- An employment agreement or contract between the physician and an eligible practice. (For details, please see the J-1 Visa Waiver Policy, Section C, 3).
- J-1 Physician’s Curriculum Vitae.
- Exchange Visitor Attestation (signed and notarized).
- Copies of all forms DS-2019 (formerly IAP-66).
- Form G-28/Letter of Representation.
- Completed Data Sheet (DS 3035).
- Statement of Reason.
- Third Party Barcode page.
- Waiver Division Barcode.
- Recruitment: Provide proof of at least six-month’s efforts by employer within the last year (does not have to be continuous) to recruit a U.S. citizen or a permanent resident physician. (For details, please see the J-1 Visa Waiver Policy, Section D, 11).
- Copy of all diplomas.
- Copy of all academic transcripts.
- Copy of all Physician Licenses and/or proof of paid application for Maryland licensure.
- Copy of Educational Commission for Medical Graduates credentials.
- Copy of U.S. Medical Licensing Examination Score Reports for Steps 1, 2 and 3.
- Letters of Recommendation.
- Sliding Fee Scale and Sliding Fee Scale Policy.
- J-1 Site Application
- Employer Attestation (signed by President/CEO and notarized)
- J-1 Visa Waiver Policy: Signed.
- J-1 Visa Waiver/National Interest Waiver Programs Verification of Employment
- Statement of No Financial obligation in Lieu of No Objection Letter (signed and notarized).
- All other forms that are required by the U.S. Department of Justice Immigration and Naturalization Service.
- An original and one copy of the entire waiver request package must be submitted.
