Medical or Dental School, or Sponsoring Entity ________________________ Date: _________ For training at the Department of Veterans Affairs health care facility in ___________________ Permanent Degree Resident or Trainee Name Program or Post Graduate Visa Type Year (PGY)
Medical or Dental School, or Sponsoring Entity ________________________ Date: _________ For training at the Department of Veterans Affairs health care facility in ___________________ Trainee Name Permanent Resident or Visa Type Program Degree or Post Graduate Year (PGY)