Health or Dental Insurance Changes
Forward completed forms below to:
ETSU Quillen College of Medicine Office of Graduate Medical Education
Box 70415
Attn: Mrs. Sissy Shipley
Johnson City, TN 37614 or call (423) 439-6373
Please do not send forms directly to insurance companies, or to the HR Deparmtent on campus. ALL insurance forms must be processed through the GME office.
BlueCross BlueShield Insurance Change Form 401k Forms
Please send the completed name, address or phone number change form to Sissy Shipley in the GME office at: shipley@etsu.edu.
Additional Forms & Information
- Change of Name Request on Official University Documents
- Change of Address and/or Phone Number
- Educational Commission For Foreign Medical Graduates (ECFMG)
- GME Leave of Absence Form
- Institutional Moonlighting Request Form
- Loan Deferment/Forbearance Information
- Medical Religious Exemption to a Clinical Affilate Vaccine Requirement Form
- Resident Check Out Form
- Resident Emergency Loan Fund Application
- Resident Patient Safety Reporting Quick Guide
- Sick Bank Enrollment Form
- Sick Bank Participation Request Form
- Tennessee for Health Workforce Development Residency Incentive Program
- Tennessee Medical Association Website
- Tennessee Medical Foundation Orientation
- Tennessee Medical Association Resident Membership Application Form
- Tennessee Medical Foundation Website
Resident-Fellow Contract