October 7, 2014
NRMP Applicant Waiver Request Form
NRMP policy requires Matching program participants to offer or accept an appointment if a match occurs, to
start training in good faith (e.g. with the intent to complete the program) on the date specified in the
appointment contract, and to remain training for a minimum of 45 days. In limited circumstances, the NRMP
may grant a waiver of a Match commitment. Applicants and programs are not authorized to release each
other from their binding commitment. Once a party has matched or a position has been offered and
accepted during the Match Week Supplemental Offer and Acceptance Program
®
(SOAP
®
), a waiver of
the binding commitment MUST be obtained from the NRMP before applicants and programs can
apply for, discuss, interview for, or accept an alternate position. The decision to grant or deny the
waiver is at the sole discretion of the NRMP and is not subject to arbitration. The Policies and Procedures
for Waiver Requests (“Waiver Policy”) governs the NRMP’s handling of waivers.
To initiate a waiver review, complete this form in its entirety and submit to policy@nrmp.org. Failure to
provide all the information requested will delay the processing of your request. Waiver reviews can
take several weeks, depending on how long it takes all parties to respond.
Upon opening the Form, click on the “Download” icon in the upper right corner of the screen to enter
data in the fields. You may contact the NRMP at 1-202-400-2235 with questions.
Date Submitted: ____________________________ AAMC/NRMP ID: _______________________
Applicant Last Name: ____________________________ Applicant First Name:___________________
Name of Match (Main or Fellowship): ________________________________ Year: ______________
Matched Program(s): ____________________________ Institution: ___________________________
____________________________ Institution: ___________________________
Program Director(s): ____________________________
____________________________
REASON FOR WAIVER REQUEST (choose only one):
_____ Unanticipated Serious and Extreme Hardship
_____ Change of Specialty or SubSpecialty* Reserved for applicants with an advanced position in the
Main Residency Match
®
or a fellowship position in the Specialties Matching Service
®
(SMS
®
).
Request must be received no later than December 15 prior to the start of training. Requests
received after December 15 prior to the start of training will NOT be approved.
_____ Ineligibility (e.g., delayed graduation, credentialing issues, no PGY-1 appointment)
2121 K Street NW, Suite 1000, Washington, DC 20037
www.nrmp.org Email: policy@nrmp.org
Toll Free: (866) 653-NRMP Phone: (202) 400-2235
_____ Visa (Is this related to inability to obtain a statement of need? Yes or No: ________________
Home Country or Country of Citizenship:____________________________________________
_____ Deferral* A deferral is not a waiver; it is a one year deferred/delayed start of training. A deferral must
be agreed to by both parties prior to submission of the request.
Please state the reason for your request. Be as detailed as possible and include timelines where
applicable. 10 point font minimum. Do not exceed parameters of the space provided. Additional
information may be submitted via email to policy@nrmp.org
Have you notified your matched program(s) of your waiver request? _____ Y _____ N
(The applicant must submit the request to the NRMP with a copy to the program(s) to which the applicant
matched or in which the applicant accepted a position.)
Have you been in contact with other programs about a position? _____ Y _____ N
If Yes, please list the name of the program(s) and the individual with whom you spoke.
Program: ____________________________ Contact: ____________________________
Program: ____________________________ Contact: ____________________________
(note: contacting a program absent a waiver from the NRMP is a potential Match violation)
Identify your current training program (if applicable):
Program: ____________________________ Institution: ____________________________
Program Director: ____________________________ Email address: ________________________
Please provide any additional information you believe is pertinent to your request. For requests based
on unanticipated, serious and extreme hardship or ineligibility, please submit to policy@nrmp.org any
third-party verification (e.g., medical information, visa documentation, medical school
correspondence) that substantiates your claim.
If the waiver is approved, what are your plans for the training year?
Please save the completed form to your desktop computer with a different filename and convert to a PDF.
Send the PDF as an attachment to policy@nrmp.org.
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