Procedures for Preventive Medicine Residency Long-Term Training
The Commissioned Corps Personnel Manual Subchapter CC25.2 “Career Development” provides rules for Commissioned Officers who are pursuing educational programs like the CDC Preventive Medicine Residency (PMR) program. The section contains information on Long Term Training that should be reviewed by each officer who is considering long-term training or a residency.
Office of Commissioned Corps Personnel (OCCP) will send officers who have applied for a PMR the necessary paperwork to enter PHS long term training. The package includes:
- PHS-1122-1 Application and Instructions
- Extramural Training Agreement (if required) (PHS-6373)
- Intramural Training Agreement (PHS-6374)
- Manual Circular copy (PHS No. 364)
- DD Form 2807-1 - Report of Medical History
- Disclosure Statement and Instructions Statement of Understanding
- DD-2808 – Report of Medical Examination (if required)
- Request for Basic Training Contract for Extramural Training (if applicable)
- Program Assessment Form (CDC 0.1116B) - will be completed by PMR staff
- Employee Assessment Form (CDC 0.1116A) - will be completed by PMR staff
- Sample of Training Purposes and Objectives Statement - will be completed by PMR staff
Applications should be received in by the designated date (please contact OCCP regarding deadline dates).
For more information, contact LCDR Amanda Dunnick.
Tips for Completing Forms
PHS 1122-1 B Application for Training for PHS
Preventive Medicine Residents will complete Pages 1 and 2, answering all questions. Do not leave any blanks, this will only cause delay in processing your application package. The Preventive Medicine Residency Program Office will complete pages 3 and 4, and write the justification for your long-term training.
Suggestions for completing Blocks 1, 14, 15, 16, and 19.
1. Type of Training for Which You Are Applying
Check Full-Time B 07/05 - 06/06 (Intramural Training Only)
Check Full-Time B 07/05 - 06/07 (Extramural and Intramural Training)
Check intramural and extramural blocks, as appropriate
14. Place training desired
Show desired institution/practicum location.
For those in extramural training, put CDC, Atlanta, GA, 07/06-06/07 on the 2nd line
15. Description of training desired
If doing both intramural and extramural, statement should read:
Academic Masters of Public Health, 07/05-06/06 and /or CDC practicum training, 07/06-06/07
If intramural only, statement should read:
CDC practicum training, 07/05-06/06
16. Reasons training requested
To complete academic/and or practicum training phase of Preventive Medicine Residency
19. Additional qualifications
Show Board Certification or Eligibility (essential in determining eligibility for Retention Special Pay for Medical Officers during training period).
Submit any transcript of college-level courses completed after entrance on active duty in PHS.
DD Form 2807-1 - Report of Medical History (Self evaluation). Complete form and and fill in the name and social security number at the top of page 2 and 3, there is not a signature space for you.. Medical Branch, DCP will complete blocks 30a and 30b, and sign in block 30c. You must be medically cleared prior to being issued personnel orders which authorize long-term training.
Disclosure Statement for Signature and Instructions for completing the exam forms
DD-2807-1 or DD-2808 if required.
PHS 6374 B Intramural Training Agreement Read the form completely before you fill in your name and sign.
Extramural Training Only:
PHS 6373 B Extramural Training Agreement Read the form completely before you fill in your name and sign.
Request for Basic Training Contract for Extramural Training. Complete when you have been accepted by your training institution and forward to Martha Smith, PMR Program Office, MS D18. The PMR Program Office will review the form for accuracy and submit to LCDR Amanda Dunnick, MS K27, Office of Commissioned Personnel. Please complete all the school information where you will be attending with complete address and phone numbers.
NOTE: The Preventive Medicine Residency office completes the Employee Assessment and Program Assessment forms.
Reasons for Non-Approval
- Change in the medical condition of an officer that would prevent him/her from fulfilling payback.
- Disciplinary action in the Officer's file.
- Low COER scores.
Generally, assume you are approved for long-term training, if none of the above actions have occurred.