Identification

                                                         

1

2

3

Enter your 

Identification 

Number.

Enter your 

name.

Indicate the 

service(s) 

for which 

you are 

providing 

payment.

Select a  

method of 

payment 

and 

complete all 

information 

requested.

Do 

NOT 

send cash.

For detailed information on ECFMG’s Payment and Refund policies, refer to the ECFMG Information Booklet and to the ECFMG website at www.ecfmg.org.

Form 900, Rev. SEP 2016

Page 1 of 1

This form is available on the ECFMG website at www.ecfmg.org.



Application for ECFMG Certification ($65)



  Application for USMLE Step 1/Step 2 CK ($880 per exam*)



Application for USMLE Step 2 CS ($1,535 per exam)



Extension of USMLE Step 1/Step 2 CK Eligibility Period    

 

($70 per exam)



Testing Region Change: USMLE Step 1/Step 2 CK  

 

($65 per region change*) 



Score Recheck: USMLE Step 1/Step 2 CK/Step 2 CS  

 

($80  per exam)   



ERAS

®

 Token ($105) – ERAS Applicants: Do NOT use this   

 

form  to pay for transmission of your USMLE transcript via    

 

ERAS. Instead, login to AAMC’s MyERAS website.



USMLE Transcript ($65 per request form – up to 10  

 

 

transcripts) – ERAS Applicants: Do NOT use this  

 

 

form  to pay for transmission of your USMLE transcript via    

 

ERAS. Instead, login to AAMC’s MyERAS website.



ECFMG Exam Chart ($50 per request form – up to three copies) 



ECFMG CSA History Chart ($50 per request form – up to 10 copies) 



CVS – State Board ($35)   



EVSP (J-1 visa sponsorship) ($285)   



Reprint ECFMG Certificate ($50)



Name Change on ECFMG Certificate ($50)



File Copy Fee ($25)



Translation Fee – Medical School Transcript ($250)

 

*International test delivery surcharges also may apply and must be 

included in payment. For the list of fees, see the ECFMG website at 

www.ecfmg.org/fees. 

Previous Balance/Other (Specify):   



$

USMLE

®

 / ECFMG

® 

Identification Number:

P

A

Y

M

E

N

T

First Name(s)

Middle Name(s)

Last Name(s) (Surname or Family Name)

Payment for Service(s) Requested

Form 900

by maIL/COURIER: ECFMG, 3624 Market Street, 4th Floor, Philadelphia, PA 19104-2685 USA

TELEPhONE: [phone]  •  Fax: [phone]  •  INTERNET: www.ecfmg.org

Generational

Suffix (Jr, Sr, 

II, III, IV)

®



Charge my credit card.

(A)

(B)

/

Credit Card 

Number:

Exp. Date 

(month/year):

Check One:

Name of Card holder:

address of Card holder:

City:

State:

Country:

Zip/Postal Code:

Signature of Card 

holder:



VISa             



maSTERCaRD             



DISCOVER             



amERICaN ExPRESS

By signing below, I authorize ECFMG to charge my credit card in the amount indicated above.



my check, bank draft, or money order made payable to ECFmG is enclosed.

Payment must be made in U.S. funds through a U.S. bank. Include your USMLE/ECFMG Identification Number on your check.