Form 172, Rev. SEP 2014, Page 1 of 2
for which results are available, as of the date the transcript is processed. For more information, see Scores &
Transcripts on the USMLE website.
have applied for or taken USMLE Step 3, or if you want your USMLE transcript sent to a state medical board, do not
use this form. See “Important Notes” below.)
included with this request form.
request for an official USMLE transcript.
Return the completed Form 172 along with payment (Form 900) by fax, to (215) 386-3185, or mail to ECFMG, 3624
Please allow approximately four weeks for your request to be processed.
Direct questions to ECFMG at (215) 386-5900 or firstname.lastname@example.org.
provide your ECFMG certification status to these entities, contact ECFMG’s Certification Verification Service or visit
to request a transcript.
ERAS Applicants: Do not use this form to request transmission of your USMLE transcript via ERAS. Instead, log into
I hereby authorize ECFMG to
The fee for requesting one through 10 official USMLE
transcripts is $65.00.
To submit payment, complete all information requested on
is included with this request form. You should check “USMLE
Transcript” in item 2 of the payment form.
Submit the completed payment form with your Request for
For office use only
that is to
copy of your
Do not use
this form to
Street Address/Post Office Box
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)
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
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
Previous Balance/Other (Specify):
Charge my credit card.
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.