Psychiatry Residency Program

Info for Matched Applicants

Illinois Program Information

As you prepare to join us, there are required documentation and training modules to complete before you arrive. This documentation is due no later than Wednesday, April 4th 2018. Information is divided into sections. Please read the directions carefully and complete each document and return it as noted in the section. Please contact us at (217) 383-4615, if you have any questions. We look forward to you joining the Psychiatry Residency Program!

Section I: Documentation that requires Original Signature

Please print the entire document, sign and mail it (along with any required documentation) to:

Linda Stone, Program Coordinator
Psychiatry Residency Program
University of Illinois
College of Medicine at Urbana-Champaign
Carle Forum, LL, MC-474
611 West Park Street
Urbana, Illinois 61801

A.) Letter of Offer and Resident Contract

Please sign and mail back a complete contract (all 4 pages) and the Letter of Offer which were attached to the Welcome Email. Once the Program Director, the Designated Institutional Officer and the Comptroller have signed your contract, a copy will be emailed back to you.

B.) Licensure Application and Instructions

Illinois has a stringent process and your training will not begin until your license is approved. It is your responsibility to go to the The Illinois Department of Professional Regulation (IDFPR) website, download and complete the license application. The IDFPR website is here for your convenience. All fees will be paid by the residency program.

NOTE: It takes 8-12 weeks to get your licensure approved, considering that ALL documentation has been submitted and is complete.

Required Documentation for Licensure Application:

  • Curriculum Vitae (Only if this has been updated since your ERAS application)
  • Original Medical College Transcripts with seal
    • For medical schools within the United States: IDFPR will accept electronic transcripts (undergrad and medical) that are sent directly from the school through a secured service such as e-script, parchment services, transcript network or other secured service. If unable to send via secured service, original hard copies must be mailed. The transcripts need to be sent to: fpr.medicalunit@illinois.gov
  • Medical School diploma (copy acceptable)
  • Original Mark Sheets, if any
  • Results of ECFMG certificate (copy acceptable)
  • Foreign Medical License (copy) or Original Certificate of Good Standing
  • For any name change, please provide supporting documentation (ie, marriage license, legal name change etc.)

Instructions:

  • Complete the four page application. A sample one is provided here.
  • CCA form must be completed by all applicants. A sample one is provided here.
  • PH form must be completed by all applicants. A sample one is provided here.
  • VE PC Form. List all activities since your medical school graduation. Most current first. Please account for every day - no gaps. A sample one is provided here.
  • CT Form. This is only needed if you have an active license. An original Certificate of Good Standing can be used as well. A sample one is provided here.
  • ED NON Form and ED MED Form. Each form must be completed by your medical school. The ED-MED form and transcript cannot be certified more than 30 days prior to the graduation date.* A sample one is provided here.
  • *Education Affidavit. For those incoming residents who are foreign graduates and whose medical college is unable to verify complete information on the ED-NON or is unwilling to complete the ED-NON, the resident must complete the Affidavit of Education based on the records in their possession and their recollection of completing the medical program. The resident must also submit proof of each attempt made to secure the ED-NON form from your medical college. A sample one is provided here.
  • CA MED Form. This form will be completed by the residency program on your behalf. A sample one is provided here.
  • Psychiatry Affidavit. The Illinois Medical Board requires a minimum of four weeks dedicated to Psychiatry. The four week psychiatry core clerkship rotation may be completed as follows: two weeks must be completed formally and distinctly in psychiatry as verified by the medical school. The other 2 weeks may be completed in other clinical rotations. For those incoming residents who have not completed the mandatory four week requirement, they are to complete a Psychiatry Affidavit. A sample one is provided here.
  • Social Security Affidavit. The Illinois Medical Board requires the Social Security Affidavit for any applicant who does not possess a Social Security Number. A sample one is provided here.
C.) J1 Visa Application

The Psychiatry office along with the Educational Commission for Foreign Medical Graduates (ECFMG) will process all J1 visa applications. All fees will be initially paid by the resident; but can be reimbursed once you have started your residency program. Please provide the Psychiatry office with receipt and proof of payment (credit card or bank statement).

Instructions

  • All sponsorship applications must be initiated by the Training Program Liaison (TPL) on-line through EVNet. To complete submission of an application for sponsorship, Steps 1-4 must be followed in the exact order listed below:
  • Paper application forms are no longer being accepted.
    • Step 1: TPL submits an on-line appointment profile through EVNet (applicants do not have access to EVNet). Applicants will be notified by Psychiatry staff when profiles have been set.
    • Step 2: Applicant will be notified by email and will accept the on-line appointment profile and complete his/her portion of the application on-line using OASIS.
    • Step 3: Applicant pays the administrative/application fee on-line using OASIS.
    • Step 4: The applicant and TPL jointly submit all required documentation as indicated on the applicant's checklist. Supporting documentation should not be submitted prior to completion of steps 1-3.
D.) Immunization Records

View a detailed listing of required immunizations here. You must provide this immunization documentation in English. Immunization documentation will be held at Office of Occupational Medicine at Carle Foundation Hospital. Please submit the documentation directly to their office: Melissa.richter@carle.com; lene.benedict@carle.com with a cc: mlim3@illinois.edu. Additionally, you will schedule your pre-employment physical with Melissa anytime during the week of June 27-June 30. Your immunization status will be reviewed and updated, if necessary.

E.) VAIHCS Appointment Application

To establish your appointment within the Veteran Administration's Danville location, please complete the forms listed here and submit to the Psychiatry office.

Acceptable Fingerprinting Documentation: (necessary during orientation)
YOU MUST HAVE AT LEAST ONE PICTURE ID

Driver’s License ID Card (State issued ID; Wallet sized doctor’s)
U.S. Passport Voter’s Registration Card
Certificate of U.S. Citizenship (Form N-560 or Form N-561) Certificate of Naturalization (Form N-550 or Form N-570)
Foreign Passport Permanent Resident Card (Form I-151 or Form I-551)
Temporary Resident Card (Form I- 688) Employment Authorization Card (Form I-688A)
Reentry Permit (Form I-327) Refugee Travel Document (Form I-571)
Employment Authorization Document (Form I-688B) U.S. Military Card
Military Dependent ID Card U.S. Coast Guard Merchant Mariner Card
Native American Tribal Document Canadian Driver’s License

Section II: Documentation Provided by Copy

Please sign and return these documents. They may be mailed with signed documentation or emailed separately to the Psychiatry office.

A.) Data Form

Include your home address and emergency contact information on the Data Form. You will be required to complete a second data sheet with US information during orientation.

B.) Drug-free Workplace Form

Please read, sign and return the Drug-free Workplace Form.

C.) Conditional Hire Acknowledgment Form

All University employees are required to complete the Conditional Hire Acknowledgment Form.

D.) Additional Required Documentation

If possible, please provide the Psychiatry office with:

  • An updated Curriculum Vitae (C.V.) Only if this has been updated since your ERAS application
  • Copy of valid US Driver's License
  • Copy of valid Social Security Card*
  • Information to apply for a Social Security Card and the documentation needed to do so can be found on the Social Security Administration Website
E.) Lab Coat Order

* required field.

Name: *

Please provide your lab coat size and name as it should appear above the top left pocket. Example: John Public MD, PhD

A sizing chart is located here.

Size: *


Do you need a long or tall version of the coat? *
Yes No


Section III: CITI Required Training


Must be completed before performing research-related activities

If you have questions regarding the CITI Training, please contact:
Mary Lyman-Parrish, BA, CIP
Human Subject Protection Specialist II
221 North Broadway, Urbana IL 61801
Office: 217/326-4509
Fax: 217/383-3993
Mary.Lyman-Parrish@carle.com

A.) CITI Required Training

View the following information to begin.


Section IV: On-Line Training Module

Contact the Psychiatry office with any questions.

A.) Introduction to Health Care Improvement Open School Online Courses (IHI)

The IHI modules are part of the University of Illinois Psychiatry Residency Program's (PRP) Quality and Safety curriculum which results in basic certification in quality and safety. It provides access to online courses created by world-renowned faculty in improvement capability, patient safety, triple aim for populations, person- and family-centered care, and leadership.

View the following information to begin.

Emergency/Extreme Weather
If conditions require the cancelling of classes or closure, the college will broadcast an announcement on this website, Facebook, Twitter, and Google+.

Review the full Emergency Action Plan.
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College of Medicine at Urbana-Champaign

506 S. Mathews Ave.
Urbana, IL 61801


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