UNITED STATES MEDICAL LICENSING EXAMINATION® (USMLE®)
CERTIFICATION OF IDENTITY (CID)
THIS IS NOT AN APPLICATION FOR STEP 3.
You must also submit a Step 3 a
pplication and fees in order for FSMB to complete your Step 3 registration.
This CID is valid for Step 3 applications submitted within five years from the date of notarization.
If you need to reapply for Step 3 within that time period, it is not necessary to submit a new CID.
USMLE/ECFMG ID:
(Type or print in uppercase letters)
Name:
Last First Middle
Date of Birth:
Email:
Phone:
I certify that I
am the individual named above, represented in the
attached photograph and that the signature below is my
si
gnature. 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.
Step 3 Applicant Signature:
We will accept an electronic/digital signature, but it must reflect your “wetor actual signature. That is, if electronic/digital, it cannot be a
typed signature. If you are not able to electronically sign your CID in a manner that reflects your actual signature, you must also submit
a copy of your drivers license or passport so that we will have a copy of your signature on file, should we need to use it later for
identification purposes.
Certification of Identification by a Notary Public/Commissioner of Oaths is Required
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.
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.
(if applicable) State of:
(if applicable)
County of:
Date of Notarization:
Notary 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 California All-Purpose Acknowledgment form to this
document.
Complete and email to:
usmle@fsmb.org
A black & white copy of your photo will NOT be
accepted.
If you mail your CID, please print your full name
on the back of the photo before attaching so that
we can identify you if the photo falls off.
Revised: September 2020
If you are unable to email
y
our completed CID,
please
contact
u
s
at
usmle@fsmb.org
ATTACH PHOTO HERE
Photo must be:
current
front view
color
passport-quality
Your photo must also be in
color on the scanned/electronic
copy or it will NOT be
accepted and you will have to
submit a new CID.
Notary Stamp or
Seal Here
(Remote/electronic
notarization is accepted.)
click to sign
signature
click to edit
click to sign
signature
click to edit
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