Attach photo here

Notary Stamp 

or Seal  

Here 

ATTACH PHOTO HERE 

Securely tape or glue in this 

square a current front view 

2”x2” color or passport 

quality photo. 

(Print your full name and 

USMLE id number on the 

back of the photo before 

attaching.) 

UNITED STATES MEDICAL LICENSING EXAMINATION® 

 STEP 3 APPLICATION 

CERTIFICATION OF IDENTITY 

NOTE: You must also submit your Step 3 application and fees in order for FSMB to complete your Step 3 registration. 

This form must be signed by a notary public/commissioner of oaths. The notary must either be in English or have an English 

translation attached. When completed and submitted to the FSMB, this form becomes part of your USMLE records and will be 

used to identify you when you interact with the FSMB.    

This Certification of Identity is valid for USMLE Step 3 applications submitted within five years from the date of your 

signature. If you need to reapply for or retake Step 3 within that time period, it is not necessary to submit a new CID.  

USMLE ID: ______________ 

Type or print in uppercase letters.

Name: 

Last 

First 

Middle 

SSN

(last 4)

:____________ Date of Birth: _________

Email: _________________________________________________ 

Daytime telephone: _______________________________________ 

________ 

I certify that I am the individual named above, represented in the attached photograph and that the signature below is my 

signature. I certify that I meet the eligibility requirements for Step 3 and that the information on this form is true and accurate. 

I also certify that I have read the most current version of the USMLE 

Bulletin of Information and all relevant instructions for 

this or any subsequent Step 3 application, that I am familiar with the contents of the 

Bulletin and agree to abide by the 

policies and procedures described therein.  

Applicant Signature ______________________________________________________________ 

Certification of Identification 

Certification by a Notary Public is required 

State of _________________________ 

County of _________________________________ 

I certify that on the date set forth below the individual names above did appear personally before me and that I did 

identify this applicant by: (a) comparing his/her physical appearance with the photograph on the identifying document 

presented by the applicant and with the photograph affixed hereto, and (b) comparing his/her signature made in my 

presence on the form with the signature on his/her identifying document.  

Date of Notarization: ______________________________________________ 

Notary Public Signature: ____________________________________________ 

Commission Expiration Date: ______________________________________ 

 _

The notary commission expiration date must be current and legible.  

If no expiration date, such as ‘lifetime’, an explanation must be provided. 

 If you are in California, the notary may attach a

 All-Purpose Acknowledgment form to this document. 

Please complete and mail this Certification of Identity form to: 

Federation of State Medical Boards 

Attn: Assessment Services 

400 Fuller Wiser Road

Euless, TX 76039-3856 

Revised: April 2016