ECFMG Eligibility Period Extension

Request to Extend a USMLE Step 1/Step 2 CK Eligibility Period (EPEx) Instructions
	Item 1. Select Exam(s) Please select the exam(s) for which you want to extend the eligibility period. Only the exam(s) for which you are currently registered will be displayed. Item 2. Name of Applicant This item provides your name as currently shown in your ECFMG record and instructions to follow if your name is not correct or has changed. Item 3. Contact Information This item provides your contact information (address of residence, telephone number, fax number, and e-mail address) as currently shown in your ECFMG record and instructions to follow if your contact information is not correct or has changed. Item 4. 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 request. Request Summary and Method of Payment This is a summary of the information you provided in the on-line part of your request. Read this request summary carefully. This is your last opportunity to make changes or corrections before making payment and submitting the on-line part of your request to ECFMG. Payment for an on-line request may be made by credit card (Visa, MasterCard, Discover, or American Express) with a security code 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 on-line request. If your payment attempt is unsuccessful, you will be able to select another payment method and try again. Student or Graduate Status Verification After you have completed payment, you must click "Continue" to proceed to information about how your student or graduate status will be verified with your medical school. If you are a student or graduate of a medical school that participates in the ECFMG Medical School Web Portal (EMSWP) Status Verification program, ECFMG will verify your status with your medical school electronically. CERTIFICATION STATEMENT (FORM 183-E) If you are a student, or a graduate whose graduate status has not been previously verified, of a medical school that does not participate in the ECFMG Medical School Web Portal (EMSWP) Status Verification program, you will be required to complete a Certification Statement (Form 183-E). Instructions for Certification Statement (Form 183-E) Print a copy of the Certification Statement (Form 183-E) by clicking your web browser's "Print" button. If a portion of the Certification Statement 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 .25 inches or 2.5 millimeters, the copy of the Certification Statement you print will be complete. Sign and date the Certification Statement (Form 183-E). The medical school official must sign and date the Certification Statement (Form 183-E) 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-E). Each medical school has been requested to provide ECFMG with a list of the officials authorized by the school to certify Form 183-E. Your Certification Statement (Form 183-E) 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-E) within 45 days of the date that it is received at ECFMG. The original, signed Certification Statement (Form 183-E) 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 form must be sent to: Intealth ECFMG Certification Program 3624 Market Street, 1st Floor Philadelphia, PA 19104 USA ECFMG must receive both the on-line part of your request and the Certification Statement (Form 183-E) in order to process your request. The processing of your request must be completed by the published deadline or your request will be rejected.