Exchange Visitor Sponsorship
Program (EVSP)
Federal regulations require that ECFMG maintain up-to-date records on the locations and activities of the exchange visitor
physicians it sponsors. This includes amending a physician’s Student and Exchange Visitor Information System (SEVIS)
record upon a physician’s resignation from his/her training program. Therefore, ECFMG must be informed immediately of a
physician’s plans to leave his/her training program in advance of the program end date listed on Form DS-2019. Once notied
of a resignation, ECFMG will adjust the individual’s SEVIS record to reect the new program end date and an e-mail will be
sent to the physician notifying him/her of the action taken by ECFMG. Exchange visitor physicians who resign are federally
required to depart the United States within 30 days of an amended SEVIS end date.
Program Director Name: Program Director Signature: Date:
TPL Name: TPL Signature: Date:
Exchange Visitor Physician Signature: Date:
Updated
April 3, 2019
Upload the completed form and any attachments to the exchange visitor physician’s current
sponsorship record via EVNet (TPL) or OASIS (EV physician).
EXCHANGE VISITOR (EV) PHYSICIAN INFORMATION
RESIGNATION DETAILS
Were there any issues
related to performance/
professionalism that factored
into the EV’s resignation?
Did the EV physician complete all requirements
of the specialty or subspecialty training program
identied above (i.e., is he/she board eligible in
the identied specialty/subspecialty)?
If training program requirements
have not been met, please identify
the months of credit, if any, that will
be given for the current training year.
If available, please upload a copy of the summative performance evaluation issued by the program.
REQUIRED SIGNATURES
Required Notification of Exchange
Visitor Physician Resignation
EV Physician Name: USMLE/ECFMG ID:
Training Institution Name: Specialty / Subspecialty:
(Site of Activity)
Reason for Resignation Last Date of Program Participation:
(i.e., personal, academic, medical)
Yes No Yes No Months
Provide a brief description of the
EV physician’s immediate plans
following exit from the program:
Provide EV physician’s forwarding
mailing address, e-mail address,
and phone number:
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signature
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