Register for the USMLE Step 1 Examination-Step-by-Step IMG Guide - IMGPrep

Register for the USMLE Step 1 Examination-Step-by-Step IMG Guide

February 5, 2021


Background: Prior to the Registering for the USMLE Step1

What is the USMLE Examination?

The United States Medical Licensing Examination (USMLE: provides a direct route for primary licensure of all graduates of LCME (Liaison Committee on Medical Education)-accredited medical schools within the United States, Canada, and all international medical graduates of accredited osteopathic medical schools.

Successful completion of the USMLE Step 1 and the USMLE Step 2 CK is required for ECFMG Certification by the Educational Commission for Foreign Medical Graduates (, officially verifying that an individual possesses the minimum clinical skills and knowledge for the unsupervised, general practice of medicine. The USMLE Step 2 CS was suspended in March 2020 due to the pandemic. On January 26, 2021, the Federation of State Medical Boards (FSMB) and National Board of Medical Examiners (NBME), co-sponsors of the USMLE, announced the end of efforts to relaunch a modified Step 2 CS. For details, see:

There are no plans to bring Step 2 CS back. Instead, both organizations will work with others to find new ways to incorporate these essential skills into the education and licensure system. For their part, the ECFMG has expanded the pathways system for the 2022 Match. For details, see:

State licensure boards utilize the USMLE to provide independent, valid, and reliable assessments to support their responsibilities for granting primary licenses to practice medicine. Additionally, undergraduate medical schools use USMLE results for curriculum assessment and graduation decisions. USMLE results are also leveraged during the residency selection process. International graduates must pass Step 1 and Step 2 CK of the USMLE for ECFMG certification.

Who is Eligible to take the USMLE Examinations?

Prior to Register for USMLE Step 1 one most establish eligibility

To be eligible, according to the USMLE, you must be in one of the following categories at the time you apply AND on the day of your examination:

  • A medical student officially enrolled in, or a graduate of, a US or Canadian medical school program leading to the MD degree that is accredited by the Liaison Committee on Medical Education (LCME), OR
  • A medical student officially enrolled in, or a graduate of, a US medical school leading to the DO degree that is accredited by the Commission on Osteopathic College Accreditation (COCA), OR
  • A medical student officially enrolled in, or a graduate of, a medical school outside the US and Canada, listed in the World Directory of Medical Schools as meeting ECFMG eligibility requirements, and that meets other eligibility criteria of the ECFMG.

If you have been dismissed or withdraw(n) from medical school, you have forfeited your ability to sit for the USMLE. More details may be found here:

Note that U.S. law limits interactions between U.S. organizations and entities in specific countries/regions, including Crimea, North Korea, and Syria. If you customarily reside in any of these locations, you cannot continue with this application.

What does the USMLE Step 1 test assess?

The Step 1 examination determines if an applicant comprehends and can apply the basic scientific concepts to the practice of medicine, with particular emphasis on principles and mechanisms underlying health, disease, and modes of therapy. The Step 1 examination ensures an applicant’s mastery of the foundations as a competent medical practitioner knowing the fundamental principles necessary for lifelong competency.

The Step 1 examination is divided into seven 60-minute blocks and administered in one 8-hour testing session. Practice materials, including Sample Test Items (PDF) and web-based Tutorial and Practice Test Items, are available at the USMLE website:

First Prepare to Register for USMLE Step 1 Exam

  • Make sure you have a current, unexpired passport.
  • All applicants for the Exam must read the relevant versions of both the ECFMG Information Booklet and the USMLE Bulletin of Information. Both are available on their respective organization’s sites and contain many essential aspects of the procedure that are too detailed for the scope of this guide.
  • Review the Frequently Asked Questions (FAQs) at:

  • Collect the medical education data necessary to complete the application. This information includes the names and addresses of medical schools you have attended or are attending, attendance dates, clinical clerkships completed, and any credits that you transferred to the medical school that awarded or will award your medical degree.
  • Check that your school is listed in the World Directory of Medical Schools AND that students and graduates from your school are eligible to apply for ECFMG certification. To do this, go to Then, select” Search,” which will take you here:
Prior to Registering for USMLE Step1 Verify your School

Fill in the information requested. When you find your school listed, check “Sponsor Notes” which will take you here as below (example school shown)
Prior to Registering for USMLE Step1 Verify your School

In “Sponsor Notes,” it must state (as in the example above) that “Students and graduates of this medical school are eligible to apply to ECFMG for ECFMG Certification and for examination‚Ķ” Also, make a note of the other listed requirements.

The Step-by-Step ”¬†Registering¬†for USMLE Step 1″ Application Guide:

Once you have made the above preparations, you are ready to begin the USMLE Step 1 application process by following the procedure (below) in this order:

Step 1: Apply for your ECFMG/USMLE identification number.

Go to The ECFMG website at and select “Online Services” as below:

Registering for USMLE Step 1:  Apply for your ECFMG/USMLE identification number


If you have never obtained an ECFMG/USMLE Identification Number, click on the appropriate option, as above. An important page of instructions for the ECFMG Online Authentication Process will appear next, which you must carefully read in its entirety. You must check both the box confirming that you have “read the above information and instructions” and the box certifying that you have “read, understood, and agree to the ECFMG Privacy Notice.” The next page then asks whether you have ever applied for ECFMG Certification or examination to the ECFMG. After confirming your answer, you will next arrive at the request form itself.

The instructions contain warnings against making incomplete or inaccurate entries. There are also special situations that may apply to you, so you need to be aware of them. If you have completed the form accurately as instructed, you should expect to receive an email confirmation with your ID number in five business days. Failing to follow the instructions correctly may lead to your request not being processed, in which case you will NOT be notified. If that happens, after a waiting period of a minimum of five business days, you will need to apply again, correctly, to obtain a USMLE/ECFMG Identification Number.

Next, click on “IWA ‚Äď Interactive Web Applications” as above, which will bring you to the page below:


Among the other details, note that it is essential to provide the spelling of your name exactly as it appears on your current, unexpired passport, or you will be required to complete additional documentation for a name change. Once you receive your USMLE/ECFMG Identification Number, the information you provided while obtaining it will become a part of your permanent ECFMG record.

Your Identification Number will arrive with your online services password, which you can change.

Step 2: Establish your account.

Go back to the IWA login page and click “here” to establish an account, as shown below:

Step2 of Registering for USMLE Step 1: Establish your account


Step 3: Complete the Application for ECFMG Certification.

You must complete the Application for ECFMG Certification before you begin an exam application. The first part of this process is to log in at the IWA as before. Access,  complete, and submit the online portion of the application by following the supplied instructions. Then make the $150 payment as directed. More payment details are at

Step 4: Complete and notarize the Certification of Identification Form 186

The second part of applying for ECFMG Certification is to complete and notarize the Certification of Identification Form 186. Since the pandemic, this has been done online through NotaryCam ( where, through virtual video calls, you can confirm your identity and sign the requested affidavit. ECFMG must accept the Application for ECFMG Certification and the notarized Form 186 before you can apply to ECFMG for examination. You can check your Application for ECFMG Certification status using ECFMG’s Online Applicant Status and Information System (OASIS)

Step 5: Complete the USMLE Step 1 application form and pay the fees.

Return to the IWA login page and log in using your USMLE/ECFMG Identification Number and your password, where shown below:


There will be another window where you click on “Begin New Application.” Fill out the application form taking care that all information is correctly entered.

You will be asked to select an eligibility period, typically of three months. For January through March of 2021, due to the pandemic, the eligibility period is greater than three months, during which you can choose to schedule your test. Ensure that the eligibility period selected is appropriate for your purposes and situation.

When applying for USMLE Step 1, selecting a suitable testing location to sit for the exam is vital. There is a list of where testing sites have been at However, the availability of the testing centers may change without notice.  Select your testing region only after visiting the Prometric website, or more specifically, or contact Prometric to ensure you have the most up-to-date information regarding availability and testing center locations for Step 1.

You must pay the USMLE Step 1 examination fee at the end of the form, currently $975. If you select any testing region other than the United States or Canada, you will be subject to paying the additional international test delivery surcharge of $180 for USMLE Step 1. There is no international surcharge for test delivery for the United States and Canada testing regions.

Step 6: Verify your medical school status either online or on paper with the Certification Statement Form 183.

With the payment process complete, a link will appear to request verification of your status as a currently enrolled student or graduate directly from your medical school. ECFMG must receive this verification before you can be registered for the USMLE. ECFMG will issue the request using its preferred method, either electronically through the ECFMG Medical School Web Portal (EMSWP) Status Verification program or on paper with the Certification Statement Form 183. ¬†If your medical school completes status verification requests electronically, you will be notified at the end of the online application process. If your medical school completes status verification requests via paper form, you will be provided with Form 183 at the end of the online USMLE application process in ECFMG’s Interactive Web Applications (IWA). Detailed instructions on how to complete and submit the form are also provided with the form.

Should your school require a paper form, Form 183 looks like this:

he Certification Statement (Form 183) is the paper verification form required by ECFMG for applicants who are either graduates of medical schools that do not participate in EMSWP Status Verification and whose credentials have not been primary-source verified or students enrolled in medical schools that do not participate in EMSWP Status Verification. A new Form 183 is generated with each application. Form 183 must be completed by the student or graduate and an authorized medical school official for each application, or the application will be rejected. See the exam application overview and instructions for details.

Form 183 USMLE- Before an applicant can be registered for USMLE, ECFMG must receive verification of the applicant’s status as a currently enrolled student or graduate directly from his/her medical school. ECFMG will request status verification from your medical school via the school‚Äôs preferred method, either electronically through the ECFMG Medical School Web Portal (EMSWP) Status Verification program or via a paper form, the Certification Statement (Form 183). If your medical school completes status verification requests via paper form, you will be provided with Form 183 at the end of the on-line USMLE application process in ECFMG‚Äôs Interactive Web Applications (IWA). If you have already completed the on-line part of an IWA exam application and need to download/reprint your Certification Statement (Form 183), access IWA.

The instructions describe in detail how to print, sign, and date paper Form 183. You then mail it to your medical school to be certified by an authorized official, who must then send it directly from their office at the school to the ECFMG to be accepted.

Step 7: Submit all other necessary documentation to the ECFMG as follows:

  • Graduates must send a copy of their medical diploma (if not previously submitted) and its official English translation if it is not in English.
  • If you transferred credits, send a copy of an official transcript issued by any school or institution from which you transferred credits to the medical school that awarded or will award your medical degree (if not previously submitted); and include the official English translation of the transcript (if the transcript is not in English). Information on transfer credits and medical education credentials are in the ECFMG¬†Information Booklet.
  • Any additional documents as required, according to the instructions, to complete your application.

Any additional documents may be submitted to ECFMG via mail at the address below.

3624 Market Street, 4th Floor
Philadelphia, PA 19104-2685

ECFMG must receive the online part of your application, the Certification Statement Form 183, and all required documents to process your application.

Step 8: Wait to receive your Scheduling Permit.

Exam applications are usually processed within two weeks of receipt of the online part, verification of your status from your medical school, and any other required documents. Eligible applicants are registered for USMLE after the processing of their application is completed.

When you receive the permit by email, make sure that everything is accurate. You will be required to bring the scheduling permit with you on Exam Day. This is the final step in your USMLE Step 1 application, but there is still more to do regarding completing registering for USMLE Step 1

Step 9: Book a test date at the Prometric website.

To schedule your USMLE Step 1 Examination, you must set an appointment using Prometric, the testing service that conducts all USMLE exams. Go to:, select the Search box and enter USMLE or go directly to

  • On the next page, click under USMLE Step 1, click “Step 1.”
  • On the Prometric website, select your preferred location to take the Exam and select “
  • On the next page, select “Schedule an Appointment.”

Once you accept the disclaimers provided by Prometric, you will be brought to a screen to set your appointment.¬† You will need your Scheduling Number (from the Permit) and the first four characters of your last name.¬†Click “submit.” Once confirmed, you will have the opportunity to select your test during your eligibility window.¬† Ensure you bring a copy of your USMLE ID number and scheduling permit to the test center.

Best of luck with your Exam!

RESOURCES: Register for USMLE Step 1

ECFMG 2021 Information Booklet:

Testing Regions and International Test Delivery Surcharges for USMLE Step 1:

Certification and Examination Fee Schedule:

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