Letter of Intent Template for Residency

LETTER OF INTENT: RESIDENCY PROGRAM APPLICATION

Document ID: TR-8842-X1
Effective Date: [____/____/2026]

INSTRUCTIONS FOR USE

• Authorized Drafter: This document is to be completed solely by the applicant. Ensure all licensure and academic claims are verifiable via primary source documentation.
• Filing & Retention: Retain a digitally signed copy in your permanent professional records for a minimum of seven (7) years following the conclusion of the residency term.
• Mandatory Attachments: Ensure this document is accompanied by: (1) Current Curriculum Vitae (CV), (2) Official Medical School Transcript, and (3) USMLE/COMLEX Transcript.

1. APPLICANT IDENTIFICATION

Full Legal Name: [____________]
AAMC/NRMP ID: [____________]
Current Institution: [____________]
Email Address: [____________]
Phone Number: [____________]

2. TARGET PROGRAM SPECIFICATIONS

Target Institution: [____________]
Program Name/Specialty: [____________]
Program ID (if applicable): [____________]
Application Type: [ ] Categorical [ ] Preliminary [ ] Advanced [ ] Combined/Other: [____________]

3. STATEMENT OF INTENT

I, the undersigned, hereby formally submit my application for the residency position identified above. I acknowledge the following:

Academic Standing: I am currently in good standing at [____________] and anticipate graduation by [____________].
Licensure Compliance: I confirm that I meet all statutory eligibility requirements for licensure as mandated by the relevant State Medical Board.
Professional Conduct: I have not been the subject of any disciplinary action, academic probation, or professional misconduct inquiry.

4. CORE OBJECTIVES & ALIGNMENT

Briefly describe your clinical focus and how it aligns with the institutional mission:

5. REPRESENTATIONS & WARRANTIES

By submitting this Letter of Intent, the applicant represents and warrants that all information provided in the supporting documentation is true, accurate, and complete. The applicant acknowledges that any misrepresentation, omission, or falsification of data may constitute grounds for immediate disqualification from the selection process or, if discovered post-appointment, summary termination of the residency contract.

6. EXECUTION

In witness whereof, the applicant has executed this Letter of Intent as of the date indicated below.

Authorized Signature: __________________________________

Printed Name: [____________]

Title: [____________]

Date: [____/____/2026]

Disclaimer: This document is provided as a standardized framework. Consult qualified legal counsel for jurisdiction-specific statutory compliance.