ECFMG may provide international medical schools with data on the performance of their students and graduates who

apply to
ECFMG for USMLE Step 1 and Step 2. At the start of the exam application, you will be presented with a notice outlining
ECFMG's practices regarding the provision of these data to international medical schools as well as the process by which you
can request to have your individual exam results withheld from your medical school. You must certify that you have read,
understood, and agree to this notice. If you do not check the box certifying that you have read, understood, and agree to this
notice, you will not be able to continue with the application.

Item 1. Physician License in the United States

Indicate whether you have already been granted a physician license by a
U.S. medical licensing authority based on other
licensure examinations, such as the Federation Licensing Examination (FLEX), the Medical Council of Canada Qualifying
Examination, NBME certifying examinations, or National Board of Osteopathic Medical Examiners COMLEX-USA.

Note: If you are a medical student, it is very unlikely that you have already been granted a physician license.

Item 2. Select an Exam

Select the exam you wish to take. After you complete Item 22 of this application, you will have the option to apply for other
exams using the same application, provided you meet the eligibility requirements for the other exams.

Item 3. Eligibility Period

Select the three-month eligibility period during which you want to take the exam.

Your application does not need to be received in advance of an eligibility period to obtain that eligibility period. To select and
obtain an eligibility period, ECFMG must receive the on-line part of your application, verification from your medical school of
your graduate or student status and any other documents required to complete your application by the 24th day of that
eligibility period, and the processing of your application must be completed by the 25th day of that eligibility period.

For all applicants, although you can select an eligibility period as late as the 24th day of that eligibility period, there is no
guarantee that you will be assigned that eligibility period, since the processing of your application may not be completed by
the 25th day of the eligibility period. If your application is not processed in time to assign the eligibility period you select, you
will be assigned to the next available eligibility period, based on the date your application is processed. Your assigned
eligibility period will not be adjusted to compensate for days that have already passed. The eligibility period assigned to you
will be listed on your scheduling permit. You must read the editions of the ECFMG Information Booklet and the USMLE
Bulletin of Information that pertain to the eligibility period in which you take the exam.

Item 4. Testing Region and International Test Delivery Surcharge, if Applicable

Select a Testing Region from the list. You must choose a testing region when you apply, but you will not choose a particular
testing center within this
region until you schedule your testing appointment. You must take the exam in the testing region you
select. You should refer to the Prometric website for
information on specific test centers. Additionally, if you plan to test in
Egypt, Hong Kong, India, or Israel, refer to the special information below.

Special Information About Testing in Egypt:

Egypt is in Prometric's Middle East testing region. If you would like to take the exam in Egypt, select Middle East.

Special Information About Testing in Hong Kong:

Hong Kong is in Prometric's Asia testing region. If you would like to take the exam in Hong Kong, select Asia.

Special Information About Testing in India:

India is in Prometric's India testing region. If you would like to take the exam in India, select India.

Special Information About Testing in Israel:

Israel is in Prometric's Europe testing region. If you would like to take the exam in Israel, select Europe.

Item 5. Examinees with Documented Disabilities

Check "Yes" only if you have a documented disability as defined by the Americans with Disabilities Act (ADA) and intend to
request test accommodations for the exam you selected. Checking "Yes" will temporarily place your scheduling permit on hold
so that you may submit your request and supporting documentation directly to the National Board of Medical Examiners®
(NBME®). You must go to the Test Accommodations section of the USMLE website at www.usmle.org to review and access all
instructions, guidelines, and forms for requesting test accommodations for USMLE examinations. Your scheduling permit will
be released after your request has been processed by NBME.
Following a review of a request for test accommodations, the eligibility period you selected in Item 3 may be adjusted, if
needed, to allow a full three-month eligibility period in which to schedule the exam.

Item 6. Name of Applicant

The name shown in Item 6 is the name in your ECFMG record. If this name is no longer your name exactly as it appears on
your current, unexpired passport, you must change the name in your ECFMG record before applying for examination. Follow
the instructions in Item 6 on how to have your ECFMG record changed.

When you arrive at the test center on the date of your exam, you must present an unexpired form of government-issued
identification that includes your name in the Latin alphabet, signature, and recent photograph (see information on acceptable
identification under Taking the Examination in the ECFMG Information Booklet). Your name, as it appears on your scheduling
permit, must match exactly the name on the form(s) of identification you present at the test center. Please review your
scheduling permit for details and limited exceptions.

Applicants with a Valid Certification of Identification Form on file:

Although the Certification of Identification Form (Form 186) is valid indefinitely once it is accepted, it must continue to bear
your name exactly as it appears on your current, unexpired passport. If your name changes in the future, you will need to
complete another Form 186 bearing your name exactly as it appears on your current, unexpired passport as part of the
application process.

Graduates Only:
If the name on your medical diploma is not your name exactly as it appears on your current, unexpired
passport, you must submit documentation that verifies that the name on your diploma is or was your name. Do not request
the name in your ECFMG record to be changed to the name on your diploma if the name on your diploma is not your name
exactly as it appears on your current, unexpired passport.

Item 7. Contact Information

You are required to provide a full and complete address for your residence. This address is where ECFMG will send you
correspondence, including your Standard ECFMG Certificate if and when earned. The three lines for street address and the
line for city (if applicable) are case-sensitive. You should use proper case when entering your address. This means you must
capitalize only the first letter of each of the words in the address and use lower case for the remainder of the letters. Do not
use all capital or all lower case letters.

U.S. law currently restricts interactions between U.S. organizations and entities in certain countries/regions, including
Crimea, North Korea, and Syria.

If you are ordinarily resident in North Korea, Crimea or Syria you cannot continue with this application. The USMLE exam
sponsors do not currently have authorization to administer examinations to individuals who are ordinarily resident in these
countries/regions. If you submit an exam application, and it is determined that you are ordinarily resident in North Korea,
Crimea or Syria, you will not be registered for USMLE.

You must also provide an e-mail address in this section. ECFMG will use this e-mail address to communicate important
information. If you do not have an e-mail address, you cannot apply for examination.

You can also enter your telephone/fax numbers. If any of your contact information (including e-mail address) has changed,
you can make the necessary changes in this item. This new contact information will be reflected in your ECFMG record after
you submit the on-line part of your application and it is processed by ECFMG.

Item 8. U.S. Social Security Number and/or National Identification Number

If you have a U.S. Social Security Number, enter it in the space provided. If you have been issued a national identification
number from a country other than the United States, enter it in the space provided and specify the country that issued it.

Item 9. Date and Place of Birth

The date shown in Item 9 is the date of birth in your ECFMG record. If this is not your correct date of birth, you must change
the date of birth in your ECFMG record before applying for examination. Follow the instructions in Item 9 on how to have your
ECFMG record changed to reflect your correct date of birth.

Enter the name of the city where you were born, the state/province where you were born (if applicable), and the country
where you were born.

Item 10. Gender

The gender shown in Item 10 is the gender in your ECFMG record. If this is not your correct gender, you must change the
gender in your ECFMG record before applying for examination. Follow the instructions in Item 10 on how to have your
ECFMG record changed to reflect your correct gender.

Item 11. Native Language

Choosing a particular answer to this question will not affect the outcome of your application. If you choose to respond, indicate
whether your native language is English or a language other than English. If your native language is not English, enter the
name of your native language.

Item 12. Other Languages Spoken

If you speak a language or languages other than English at home, indicate the language(s) spoken. Check all that apply.
Although you are encouraged to complete this item, providing this information is voluntary. This information will be used for
research purposes and will be kept confidential. Choosing a particular answer or answers, or choosing not to answer this
question, will not affect the outcome of your application.

Item 13 A. Citizenship
Select the country of your citizenship at birth, upon entering medical school, and now.
Indicate whether you are/have been a
U.S. Permanent Resident (Green Card Holder). If you answer "Yes," enter the year in which you obtained this status.

Item 13 B. Current Passport

Select the country that issued your current passport and provide your passport number and expiration date. If you do not have
a current passport, check the box in Item 13 B.

Item 14. Ethnicity

Select the option(s) that best describe(s) your ethnicity. Select all that apply. Although you are encouraged to complete this
item, providing this information is voluntary. This information will be used for research purposes and will be kept confidential.
Choosing a particular answer or answers, or choosing not to answer this question, will not affect the outcome of your
application.

Item 15 A. Present Employment

Indicate whether you are currently employed. If you answer "Yes," enter the name of the institution/company where you are
employed, the institution/company address, the type of position, job title, and the date you started employment at that
institution/company. If you are employed as a Physician or Resident/Fellow/House Officer, select your clinical
discipline/specialty from the list.

Item 15 B. Postgraduate Medical Training

Indicate whether you have completed a program of postgraduate medical/surgical training. If you answer "Yes," select from
the lists the clinical discipline/specialty and the country where you completed the training.

Item 16. The ECFMG® Reporter

The ECFMG® Reporter provides important information regarding the ECFMG certification process and entry into graduate
medical education in the United States. The ECFMG® Reporter
may also advise you of services and programs offered by
other organizations in connection with the certification process or graduate medical education in the United States.

The ECFMG® Reporter is a free publication. Interested individuals

can join or leave The ECFMG® Reporter subscriber list or
update their e-mail
addresses at any time by visiting the ECFMG website at www.ecfmg.org/reporter/index.html or by writing
to: Assistant Vice President, Communications & Outreach, ECFMG, 3624 Market Street, Philadelphia, PA, 19104-2685, USA.

All applicants should subscribe to The ECFMG® Reporter. If you wish to receive The ECFMG® Reporter, check the box in
Item 16.

Item 17. Medical Education Status

Both ECFMG and USMLE policy require that, to be eligible for a USMLE exam, you must be either a medical school student
officially enrolled or a medical school graduate both at the time you apply AND on your test day. Certifying in Item 17 that you
are currently a student officially enrolled in medical school when you are not officially enrolled may result in a determination of
irregular behavior. See Eligibility for Examination in the applicable edition of the ECFMG Information Booklet.

For students: if you are dismissed or withdraw(n) from medical school, you are not eligible for USMLE, even if you are
appealing the school's decision to dismiss you or are otherwise contesting your status.

For students: if you take a leave of absence from medical school, you should consult with your school about whether
you will be considered officially enrolled in medical school during leave. Your medical school may consider a student
on leave of absence to be withdrawn from medical school. You are not eligible for USMLE if you are considered
withdrawn.

In some countries, in addition to completing the medical school curriculum, individuals must complete a period of internship
and/or social service or fulfill other requirements, such as a thesis or state/national examination, to be eligible for the final
medical diploma.

If you are in the process of completing the requirements to be eligible for the final medical diploma, you should indicate
you are a "student."

If you have completed the requirements to be eligible for the final medical diploma, you should indicate you are a
"graduate," regardless of whether your final medical diploma has been issued.

Item 18. Medical School Information

Highlight the country where the medical school from which you graduated or expect to graduate is located and click the
"Select" button to view the list of medical schools in that country that are currently listed in the World Directory of Medical
Schools (World Directory)
with an ECFMG note stating they meet eligibility requirements for their students and graduates to
apply to ECFMG for ECFMG Certification and examination.

Select the name of the medical school from which you graduated or expect to graduate. The address of the medical school
will appear below.

If you are not able to identify your medical school in this list, click "search" for expanded search options.

If your medical school assigned you a unique student Identification Number, enter that number. ECFMG will provide your
medical school with this number if your medical school participates in EMSWP Status Verification. This will assist your
medical school in identifying you for the purpose of verifying your status.

Also enter your dates of attendance and number of years attended at this school, your graduation date, the date your medical
diploma was or will be issued, and the title of the medical degree. Attendance dates should be listed only for the medical
school that awarded or will award your medical degree; attendance dates for any other medical schools or institutions that you
previously attended should be listed in Items 19 and 20, respectively. For a list of the degree titles acceptable to ECFMG,
refer to the Reference Guide for Medical Education Credentials on the ECFMG website.

If you are or were required to complete an internship prior to receiving your medical diploma, enter the start and end dates of
your internship. If you are or were required to complete a period of government or social service prior to receiving your
medical diploma, enter the start and end dates of your government or social service.

Item 19. Other Medical School(s) Attended

Indicate whether you attended any medical school(s), or were enrolled in any medical school(s), other than the medical
school you entered in Item 18. For institutions other than medical schools, see Item 20.

You must add all medical schools you ever attended or were formally enrolled in (other than the medical school you already
listed in Item 18), even if you attended a medical school for a short period of time and/or transferred no credits from a medical
school. If you have questions about whether you must list a medical school in Item 19, contact ECFMG Applicant Information
Services at (215) 386-5900 or [email protected].

To add a medical school, click "Add." To edit or delete a medical school, select the medical school from the list and click "Edit"
or "Delete." When you have entered all your medical schools, click "Next" to continue.

Item 19 A. Add Other Medical School

Highlight the country where the medical school you previously attended is located and click the "Select" button to view a list of
medical schools in that country that are currently listed in the World Directory of Medical Schools (World Directory) with an
ECFMG note stating they meet eligibility requirements for their students and graduates to apply to ECFMG for ECFMG
Certification and examination.

Select the name of the medical school you previously attended. The address of the medical school will appear below.

If you are not able to identify the medical school in this list, click "search" for expanded search options.

If the medical school does not appear in the list, check "Medical School Not Found" and enter the full, official name of the
medical school, the country where the school is located, the official address of the medical school, and the name of the
university with which the medical school is affiliated (if applicable).

If this medical school assigned you a unique student Identification Number, enter that number. Also enter the dates of
attendance and number of years attended at this school. Attendance dates should be listed for this school only; do not include
attendance dates for the medical school that awarded or will award your medical degree.

Indicate whether you transferred credits from this medical school to the medical school that awarded or will award your
medical degree.

To add credits, click "Add." To edit or delete credits, select the course from the list and click "Edit" or "Delete." When you have
entered all your transfer credits, click "Save" to continue.

Item 19 B. Transfer Credits

Transfer credits refer to any course work completed at another medical school or institution for which you were awarded credit
by the medical school you entered in Item 18. These courses may appear on your final transcript as "transferred" or "exempt."
If you are unsure of your transfer credit status, please contact your medical school.

For each transferred course, list the title of the course, the number of credits earned, indicate whether the course was passed
at the medical school at which it was taken, and enter the date the credits were earned. List each course title exactly as it
appears on the official transcript from the medical school at which the course was taken.

You must document these credits at the time of application by submitting a copy of an official transcript from the medical
school at which the course was taken. Additional documentation may be required. Please see Transfer Credits in the
applicable edition of the ECFMG Information Booklet. You must disclose and document these credits, regardless of
when they were earned. Failure to disclose and document these credits may have a number of negative consequences,
including delaying exam registration and certification by ECFMG, and may result in a finding of irregular behavior. See
information on transfer credits and medical education credentials in the applicable edition of the ECFMG Information Booklet.

Item 20. Other Institution(s) Attended

Enter any institution other than a medical school from which you transferred credits to the medical school that awarded or will
award your medical degree. You should only enter this information if the credits you transferred from this institution to the
medical school that awarded or will award your medical degree were applied to completion of the requirements for the
medical degree.

To add an institution, click "Add." To edit or delete an institution, select the institution from the list and click "Edit" or "Delete."
When you have entered all your institutions, click "Next" to continue.

Item 20 A. Add Other Institution Attended

For each institution other than a medical school from which you transferred credits to the medical school that awarded or will
award your medical degree, enter the official name and address of the institution from which the credits were transferred.

To add credits, click "Add." To edit or delete credits, select the course from the list and click "Edit" or "Delete." When you have
entered all your transfer credits, click "Save" to continue.

Item 20 B. Transfer Credits

Transfer credits refer to any course work completed at another medical school or institution for which you were awarded credit
by the medical school you entered in Item 18. These courses may appear on your final transcript as "transferred" or "exempt."
If you are unsure of your transfer credit status, please contact your medical school.

For each transferred course, list the title of the course, the number of credits earned, indicate whether the course was passed
at the institution at which it was taken, and enter the date the credits were earned. List the course title exactly as it appears on
the official transcript from the institution at which the course was taken.

You must document these credits at the time of application by submitting a copy of an official transcript from the institution at
which the course was taken. Additional documentation may be required. Please see Transfer Credits in the applicable edition
of the ECFMG Information Booklet. You must disclose and document these credits, regardless of when they were
earned. Failure to disclose and document these credits may have a number of negative consequences, including delaying
exam registration and certification by ECFMG, and may result in a finding of irregular behavior and permanent annotation of
your ECFMG record. See information on transfer credits and medical education credentials in the applicable edition of the
ECFMG Information Booklet.

Item 21. Clinical Clerkships

The term clinical clerkships refers to that period in your medical education in the clinical disciplines during which, as a medical
student, you gained practical experience in hospitals or clinics through rotations, pregraduate internships, etc.

To enter a clinical clerkship, click "Add." To edit or delete a clinical clerkship, select the clinical clerkship from the list and click
"Edit" or "Delete." When you have entered all your clinical clerkships, click "Next" to continue.

Item 21 A. Add Clinical Clerkship

For all clinical clerkships, select the clinical discipline from the list, and enter the name of the hospital/clinic, the hospital/clinic
address, and the name of the physician who supervised the clinical clerkship. You must also provide the dates of the clinical
clerkship.

Item 22. Graduates Only

Medical Diploma
Indicate which of the following statements applies to you.

I have graduated from medical school and have previously submitted to ECFMG a copy of my medical diploma.

I have graduated from medical school and am submitting a copy of my medical diploma with an English translation (if
required).

I have graduated from medical school, but my medical diploma has not been issued. I am submitting a letter from my medical
school that confirms I graduated, have met all requirements to receive my medical diploma, and states the date my medical
diploma will be issued (refer to Eligibility for Examination in the ECFMG Information Booklet for the exact language required in
this letter); and an English translation of the letter (if required).
Name on Medical Diploma: If the name in your ECFMG record is correct but this name does not match exactly your name
as listed on your medical diploma, you must submit documentation that verifies the name on your diploma is or was your
name. Do not request the name in your ECFMG record to be changed to the name on your diploma if the name on your
diploma is not your name exactly as it appears on your current, unexpired passport. If you do not provide acceptable
documentation that verifies your name, your application will be rejected. Enter your name as it appears on your medical
diploma or letter from your medical school.

Item 22. Students Only

Status of Medical School Student
Answer "Yes" or "No" to each question concerning your status as a medical school student. If you answer "No" to either
question, you are not eligible for examination.

The minimum eligibility requirements for medical school students are:

To be eligible for Step 1 or Step 2 CK you must be officially enrolled in a medical school located outside the United States and
Canada that is listed in the World Directory of Medical Schools (World Directory) with an ECFMG note stating that it meets
eligibility requirements for its students and graduates to apply to ECFMG for ECFMG Certification and examination, both at
the time that you apply and on your test day. In addition, the "Graduation Years" in the ECFMG note on the Sponsor Notes tab
of your medical school's World Directory listing must be listed as "Current" at the time you apply and on your test day. As soon
as you graduate and receive your medical diploma, you must submit a copy of your medical diploma to ECFMG (see Medical
Education Credentials in the ECFMG Information Booklet).

In addition to being currently enrolled as described above, to be eligible for Step 1 or Step 2 CK you must have completed at
least two years of medical school. This eligibility requirement means that you must have completed the basic medical science
component of the medical school curriculum by the beginning of your eligibility period.

ECFMG reserves the right to reverify with the medical school the eligibility of medical school students who are registered for
an exam. If your medical school informs ECFMG that your status has changed, and ECFMG verifies you are no longer eligible
for examination, your registration will be canceled. If ECFMG requests reverification of your student status with your medical
school after you have taken an examination, your score report will be issued only after reverification of your status has been
received by ECFMG.

Item 23. Certification by Applicant

You must read the Certification by Applicant statement and click the check box to indicate that you have read, understood,
and agree to the statement. If you do not click the check box, you will not be able to proceed with your application.

Application Summary and Method of Payment

This is a summary of the information you provided in the on-line part of your application.
Read this application summary
carefully. This is your last opportunity to make changes or corrections to the information before making payment and
submitting the on-line part of your application to ECFMG.

Payment for an on-line application may be made by credit card (Visa, MasterCard, Discover, or American Express) or by
electronic check (U.S. bank accounts only). Once your payment is approved, you will be able to proceed to the final part of
the application, which provides information about
verification of your status as a medical school student or graduate. If your
payment attempt is unsuccessful, you will be able to select another payment option and try again.

Status Verification
ECFMG will request verification of your status as a currently enrolled medical school student or graduate from your medical
school via the school's preferred method, either electronically through the ECFMG Medical School Web Portal (EMSWP)
Status Verification program or via a paper form (Certification Statement Form 183). If your medical school completes status
verification requests electronically, you will be notified at the end of the on-line application process. If your medical school
completes status verification requests via paper form, you will be provided with the form at the end of the on-line application
process.

CERTIFICATION STATEMENT (FORM 183)

If your medical school completes status verification requests via paper form, you will be required to complete a Certification
Statement (Form 183).
Your next step is to print the Certification Statement (Form 183). The Certification Statement (Form 183) must be completed
by you and certified by an authorized official of your medical school. The official must provide his/her name, official title, and
the institution name. The official must affix the institution's seal in the designated section of the Certification Statement (Form
183). Each medical school has been requested to provide ECFMG with a list of the officials authorized by the school to certify
Form 183. Your Certification Statement (Form 183) must be certified by an official on this list. Contact your medical school to
determine the officials authorized by your medical school for this purpose; ECFMG will not provide this information to
applicants. If your form is not signed by an authorized official, it will not be accepted. The Certification Statement (Form
183) must be sent to ECFMG directly from the office of the medical school official who certified the form. If the form is not
sent to ECFMG from the office of the medical school official, it will not be accepted. It must be sent to ECFMG as soon
as possible, and the certifying official must have signed the form within four months of its receipt at ECFMG.

Your application does not need to be received in advance of an eligibility period to obtain that eligibility period. To select and
obtain an eligibility period, ECFMG must receive the on-line part of your application, verification of your student or graduate
status by your medical school, and any other documents required to complete your application by the 24th day of that
eligibility period, and the processing of your application must be completed by ECFMG by the 25th day of that eligibility
period. It typically takes two weeks from receipt of a complete application for ECFMG to process the application. This means
that, although you can select an eligibility period as late as the 24th day of that eligibility period, there is no guarantee that you
will be assigned that eligibility period, since the processing of your application may not be completed by the 25th day of the
eligibility period. If the processing of your application is not completed in time to assign the eligibility period you select, you will
be assigned to the next available eligibility period, based on the date your application is processed. Your assigned eligibility
period will not be adjusted to compensate for days that have already passed. The eligibility period assigned to you will be
listed on your scheduling permit.

Instructions for Certification Statement (Form 183)

Print a copy of the Certification Statement (Form 183) by clicking your web browser's "Print" button. If a portion of the
Certification Statement (Form 183) is cut off on the copy that you print, you will need to adjust the margins under "Page
Setup" in your browser. Generally, if you set all margins in your browser to 0.25 inches or 2.5 millimeters, the copy of
the Certification Statement (Form 183) you print will be complete.

Sign and date the Certification Statement (Form 183). The medical school official must sign and date the Certification
Statement (Form 183) and provide his/her name, official title, and the institution name. The official must affix the
institution's seal in the designated section of the Certification Statement (Form 183). Each medical school has been
requested to provide ECFMG with a list of the officials authorized by the school to certify Form 183. Your Certification
Statement (Form 183) must be certified by an official on this list. Contact your medical school to determine the officials
authorized by your medical school for this purpose; ECFMG will not provide this information to applicants. If your form
is not signed by an authorized official, it will not be accepted. The signature of the official must be current; the
official must have signed the Certification Statement (Form 183) within four months of the date that it is received at
ECFMG. The form must be sent to ECFMG directly from the office of the medical school official who certified the form.
If the form is not sent to ECFMG from the office of the medical school official, it will not be accepted.

The following documents must also be submitted to ECFMG:

1. Graduates only: A copy of medical diploma (if not previously submitted) and official English translation of
medical diploma (if diploma is not in English).

2. If you transferred credits to the medical school that awarded or will award your medical degree, a copy of an
official transcript issued by any school or institution from which you transferred credits to the medical school that
awarded or will award your medical degree (if not previously submitted); and official English translation of
transcript (if transcript is not in English). For information on ECFMG's translation requirements and
recommended translation vendor, see English Translations in the ECFMG Information Booklet. See information
on transfer credits and medical education credentials in the applicable edition of the ECFMG Information
Booklet.

3. Any additional documents required to complete your application.

Any additional documents may be submitted to ECFMG via mail at the address below, or they may be submitted by
you via the ECFMG Credentials Upload Tool.

IWA
ECFMG
 3624 Market Street, 4th Floor
Philadelphia, PA 19104-2685
USA

ECFMG must receive the on-line part of your application, the Certification Statement (Form 183), and all required documents
to process your application.