Special Activity Certificate

Special Activity Certificate Application

The holder of a special activity certificate may practice medicine and surgery or osteopathic medicine and surgery only in conjunction with the special activity, event or program for which the certificate is issued. A special activity certificate is valid for the shorter of thirty days or the duration of the special activity, program or event. The certificate may not be renewed.

Click here for eligibility requirements. Apply online at eLicense.ohio.gov. You will also need to complete a Verification of Activity form.


Please note: the Medical Board is unable to confirm receipt of supporting documents prior to an application being submitted. 

Once an application has been submitted, any documents that have been previously received will be attached to the application. Please allow the Board 10 business days to perform an initial review of your application. After that time, you may check the status of your application by logging into eLicense and navigating to your license application. Select the Options tab and the Review Status option. Any outstanding items will be listed in the ‘Comments’ section at the bottom of the page.


List of Disqualifying Offenses

Explanatory Statement Disqualifying Offense List 

Disqualifying Offense List 


Initial Application Fees

Application $125.00

Transaction fee $3.50

Total due at submission $128.50