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Request to Change Applicant Biographic Information Form 182 Request to Change Applicant Biographic Information
Form 182
You can check and update the mailing address, phone and fax numbers, and e-mail address* in your ECFMG
®

record on-line using ECFMGs On-line Applicant Status and Information System (OASIS). You can access OASIS on
ECFMGs website at www.ecfmg.org. You can also submit the Request to Change Applicant Biographic Information
(Form 182) to change this information.
To change the name in your ECFMG record, you must submit Form 182 and the required documentation, as
described below. Although you can check the name in your ECFMG record using OASIS, you cannot use OASIS to
change your name. To correct your date of birth, you must submit Form 182 and the required documentation. To
correct your gender, you must contact ECFMG Applicant Information Services at (215) 386-5900 or info@ecfmg.org
for more information.
INSTRUCTIONS
You may use this form to request changes to the following components of your applicant record: name, address,
date of birth, telephone and fax numbers, and e-mail address*. Complete all sections on pages 3 and 4 of this form
and submit the entire form to ECFMG at the fax number or address listed on page 3.

If you are requesting a change of name, you must:
1)
Read the ECFMG Policy on Name Changes on page 2 of this form,
2)
Complete Form 182 and sign it in the appropriate section,
3)
Attach a photocopy of one of the acceptable documents for name change (see policy on page 2),
4)
Submit Form 182 to ECFMG. ECFMG will notify you when your name has been changed in your
ECFMG record. If your request cannot be processed because you did not submit acceptable


documentation or it was otherwise incomplete, ECFMG will notify you.


If you are submitting this request in conjunction with an IWA exam application, fax your completed
request and documentation to (215) 386-6327, Attn: IWA/Biographic Change. You must wait to receive
ECFMG
e-mail
con rmation that the name has been changed in your ECFMG record before you may
proceed with your application. You will be noti ed regarding the status of your request within approximately
10 business days of receipt of your completed Form 182 and documentation.
If you are requesting a date of birth correction, you must:
1)
Read the ECFMG Policy on Date of Birth Correction on page 2 of this form,
2)
Complete Form 182 and sign it in the appropriate section,
3)
Attach a photocopy of one of the acceptable documents for date of birth correction (see policy on page 2),
4)
Submit Form 182 to ECFMG. ECFMG will notify you when your date of birth has been corrected in your
ECFMG record. If your request cannot be processed because you did not submit acceptable documentation
or it was otherwise incomplete, ECFMG will notify you.
If you are submitting this request in conjunction with an IWA exam application, fax your completed
request and documentation to (215) 386-6327, Attn: IWA/Biographic Change. You do not need to wait for
this change to be effective in order to complete your application.
* Important Note: Changing your e-mail address using OASIS or Form 182 does not update your e-mail address in ECFMGs e-newsletter
subscriber lists. If you change your e-mail address and are subscribed to one or more of ECFMGs e-mail newsletters, such as The ECFMG
®

Reporter, you must update your e-mail address for each e-newsletter. Visit the Publications page of the ECFMG website at www.ecfmg.org,
click on the newsletter(s) you receive, unsubscribe your old e-mail address, and subscribe your new e-mail address.
Form 182, Rev. AUG 2008
Page 1 of 4
® Request to Change Applicant Biographic Information
Form 182
Form 182, Rev. AUG 2008
Page 2 of 4
ECFMG POLICY ON NAME CHANGES
You must ensure that the name in your ECFMG record is your correct and current legal name. This name will
appear on your Standard ECFMG Certi cate once you have met all requirements for certi cation. You must use
this name consistently in all communications you send to ECFMG, including exam applications and requests for
other services. Failure to use the name in your ECFMG record consistently in all communications with ECFMG
may delay exam registration. It may also prevent you from taking an exam for which you are registered and
scheduled.
If you have legally changed your name and want to request a change of name in your ECFMG record,
your request must be accompanied by a copy of one of the unexpired, legal documents listed below:
Passport (including the page with your photograph),
Birth certi cate,
Marriage certi cate,
Of cial court order,
U.S. Resident Alien Card,
U.S. Naturalization Certi cate, or
National Identity Card.
Attestations and af davits are not acceptable as documentation to change your name.
Please do not submit an original document; a copy of the document is suf cient.
All documents submitted to change your name that are not in English must be accompanied by an of cial English
translation. (See English Translations in the ECFMG Information Booklet.)
All documents submitted to change your name will become a part of your permanent ECFMG record.
For complete information, see Name of Applicant and Changing or Verifying Your Name in the ECFMG Information
Booklet.
ECFMG POLICY ON DATE OF BIRTH CORRECTION
If your date of birth is not correct in your ECFMG record, your request for correction must be accompanied
by a copy of one of the following:
Passport (including the page with your photograph) or
Birth certi cate.
Attestations and af davits are not acceptable as documentation to correct your date of birth.
Please do not submit an original document; a copy of the document is suf cient.
All documents submitted to correct your date of birth that are not in English must be accompanied by an of cial
English translation. (See English Translations in the ECFMG Information Booklet.)
All documents submitted to correct your date of birth will become a part of your permanent ECFMG record.
® Request to Change Applicant Biographic Information
Form 182
INSTRUCTIONS: Complete the applicable sections in ink, referring to the instructions that accompany this form.
Sign where indicated, and return to ECFMG
®
by fax to: (215) 386-6327, Attn: IWA/Biographic Change, or
by mail to: ECFMG, 3624 Market Street, Philadelphia, PA 19104-2685 USA.
1

(Must be
completed.)
Enter your name as it currently appears in your ECFMG record in the spaces below.
2


(Must be

completed.)
First Name(s)
Middle Name(s)
USMLE / ECFMG
Identi cation Number:
3


Name Change
(Check the box
and complete this
section ONLY if
you are requesting
a name change.)
I have read the ECFMG Policy On Name Changes on page 2 of this form and wish to change the name in
my ECFMG record to the name below. I have attached documentation, as described on page 2.
Last Name(s) (Surname/Family Name)
Generational Suf x
(Jr, Sr, II, III, IV)
First Name(s)
Middle Name(s)
4


Change of
Address, Phone,
Fax, or E-mail
Address
(Check the box
and complete
this section
ONLY if you are
requesting a
change of
address or
other contact
information.)
I have changed my mailing address, telephone number, fax number, and/or e-mail address, as follows:
Street Address/Post Of ce Box
Address Continued
City (Include Postal Code as required for non-U.S./non-Canadian address.)
State/Province
ZIP/Postal Code
Country
Country
Code
City/Area
Code
Telephone Number
Country
Code
City/Area
Code
Fax Number
E-mail Address (If changing your e-mail address, see Important Note on page 1.)
5


(Must be
completed.)
Enter your date of birth as it currently appears in your ECFMG record in the spaces below.
Last Name(s) (Surname/Family Name)
Generational Suf x
(Jr, Sr, II, III, IV)
Form 182, Rev. AUG 2008
Page 3 of 4
BIOGRA
P
HI
C
C
H
A
N
G
E
(Month/Day/Year)
® 6


Correction of
Date of Birth
(Check the box
and complete
this section
ONLY if you are
requesting a
correction of your
date of birth.)
I have read the ECFMG Policy on Date of Birth Correction on page 2 of this form and wish to change the
date of birth in my ECFMG record to the date of birth below. I have attached documentation, as described on
page 2.
7


Signature
(Must be
completed.)

I hereby authorize ECFMG to change the information in my applicant record as noted above.
(Note: The requested change(s) will not be made without your signature.)
Request to Change Applicant Biographic Information
Form 182
Form 182, Rev. AUG 2008
Page 4 of 4
BIOGRA
P
HI
C
C
H
A
N
G
E
Signature (Using the Latin Alphabet)
Date (Month/Day/Year)
(