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
), 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 email@example.com. 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
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)