Form 345-I, Rev. Sep 2014 Page 1 of 1
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- Bu səhifədəki naviqasiya:
- If you are applying to ECFMG for an examination and you do not have a valid Certification of Identification (Form 186) on file with ECFMG
- If you have a valid Certification of Identification Form on file with ECFMG
- Date of Graduation
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Medical School Release Request Form 345-I
Form 345-I, Rev. SEP 2014 Page 1 of 1
You must submit the Medical School Release Request (Form 345) when you send your final medical diploma to ECFMG ® . The Medical School Release Request (Form 345) is addressed to your medical school. By completing this form, you are authorizing your medical school, if requested by ECFMG, to provide and/or verify your medical credentials and provide information on your medical education. ECFMG will send a copy of your completed Medical School Release Request (Form 345) to your medical school with its request.
Complete the Medical School Release Request (Form 345) by printing the name and address of your medical school (the medical school from which you graduated), your name, USMLE ® / ECFMG Identification Number, your date of birth, and month and year of graduation from medical school in the spaces provided. You must also attach a current, full-face, passport-sized color photograph of yourself, and sign and date the form where indicated.
Submit two copies of the completed Medical School Release Request (Form 345) to ECFMG with your medical education credentials.
Certification of Identification (Form 186) on file with ECFMG, the completed copies of the ECFMG Medical School Release Request (Form 345), medical education credentials, photograph, and any other required documents must be sent with your Certification of
envelope. If your Form 186 is signed by an authorized official of your medical school, this envelope must be sent to ECFMG directly from the office of that official. If your Form 186 is certified only by a Consular Official, Notary Public, First Class Magistrate, or Commissioner of Oaths, this envelope can be sent to ECFMG by you.
documents outlined above to ECFMG in one envelope.
education credentials and associated forms and documents.
These forms and documents must be sent to: ECFMG 3624 Market Street, 4 th Floor
Philadelphia, PA 19104-2685 USA
The Medical School Release Request (Form 345) is available on the ECFMG website at www.ecfmg.org.
Medical School Release Request Form 345
Form 345, Rev. SEP 2014 Page 1 of 1
PHOTOGRAPH: Attach a current, full-face, passport-sized color photograph of yourself here. Use tape or glue; no staples or paper clips please.
A photocopy of your photograph is not acceptable. Please complete, sign, and date this form. This form must be sent to ECFMG with your medical education credentials.
Name of Medical School
City, State/Province, Postal Code
Country Re: Name:
Applicant Name – Last First Middle
USMLE/ECFMG ID No. ---
Day / Month / Year
Date of Graduation: Month / Year
Dear Sir or Madam:
I am currently applying to the Educational Commission for Foreign Medical Graduates (ECFMG ® ). To facilitate this process, I hereby request:
• An official, final medical school transcript which bears your institution’s seal and the signature of an authorized official; and
• Certification of my Final Medical Diploma, by affixing the institution’s seal and the signature of an authorized official onto the diploma; and
• An authorized official of your Medical School to provide the requested information on my medical education.
If you have any questions about this process, please contact ECFMG by e-mail at deansbox@ecfmg.org. Thank you for your assistance.
Sincerely,
Signature of Applicant
Date of Signature
Medical School Release Request Form 345
Form 345, Rev. SEP 2014 Page 1 of 1
PHOTOGRAPH: Attach a current, full-face, passport-sized color photograph of yourself here. Use tape or glue; no staples or paper clips please.
A photocopy of your photograph is not acceptable. Please complete, sign, and date this form. This form must be sent to ECFMG with your medical education credentials.
Name of Medical School
City, State/Province, Postal Code
Country Re: Name:
Applicant Name – Last First Middle
USMLE/ECFMG ID No. ---
Day / Month / Year
Date of Graduation: Month / Year
Dear Sir or Madam:
I am currently applying to the Educational Commission for Foreign Medical Graduates (ECFMG ® ). To facilitate this process, I hereby request:
• An official, final medical school transcript which bears your institution’s seal and the signature of an authorized official; and
• Certification of my Final Medical Diploma, by affixing the institution’s seal and the signature of an authorized official onto the diploma; and
• An authorized official of your Medical School to provide the requested information on my medical education.
If you have any questions about this process, please contact ECFMG by e-mail at deansbox@ecfmg.org. Thank you for your assistance.
Sincerely,
Signature of Applicant
Date of Signature Document Outline
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