UNITED STATES MEDICAL LICENSING EXAMINATION (USMLE)

2003 Step 1 and Step 2 Application Instructions

for Students/Graduates of US/Canadian Medical Schools National Board of Medical Examiners (NBME) 3750 Market Street, Philadelphia, PA 19104-3190 (215) 590-9700 Website: http://www.nbme.org

APPLYING FOR STEP 1 OR STEP 2 Use the 2003 Step 1 and Step 2 application form below to apply for an eligibility period that ends in the year 2003. Eligibility periods are listed on the application in Item 3. If you want to select an eligibility period that ends in 2004, you should use the 2004 application which will be available in summer 2003. Application must be made on the current, official form each time you apply for Step 1 or Step 2. Information regarding eligibility requirements, exam content, scheduling your exam, testing, scoring, and score reporting appears in the 2003 Bulletin of Information on the USMLE website at www.usmle.org. Read the Bulletin carefully before completing your application.

ELIGIBILITY REQUIREMENTS At the time you submit your application and at the time you take the exam, you must be officially enrolled in, or a graduate of See page 3 in the 2003 USMLE Bulletin of Information for further information. If your eligibility status changes after you submit your application, you must contact the NBME immediately at (215) 590-9700.

a US or Canadian medical school program leading to the MD degree that is accredited by the Liaison Committee on Medical Education (LCME) a US medical school that is accredited by the American Osteopathic Association (AOA)

APPLICATION MATERIALS Application materials, available on the NBME website at www.nbme.org, include:

Disability Services Guidelines for documenting requests for test accommodations Content Description and Sample Test Materials for Steps 1 and 2

2003 Step 1 and Step 2 Application and Instructions 2003 USMLE Bulletin of Information

The 2003 tutorial and sample test for each Step is available on the USMLE website at www.usmle.org. COMPLETING YOUR APPLICATION

Applications are processed by date of receipt. Allow three to four weeks for processing. Complete the application, printing clearly in block letters and in black ink:

Item 1 USMLE Identification Number: Enter this number if you know it. If you are applying for your first Step, a USMLE ID Number will be assigned to you and it will appear on your scheduling permit (see p. 3). This number should be used in all future correspondence regarding USMLE. Item 2 Examination: Check one box only. Item 3 Eligibility Period: Select one three-month period for testing. To allow time for 1

processing, select a period that begins at least four weeks after you plan to submit your completed application. You will be assigned to the period you select unless you have taken and failed this exam less than sixty days before the period begins or you have taken and failed this exam three times within a twelvemonth period. In either case, you will be assigned to the first period for which you're eligible. Note: Steps 1 and 2 are not available during the first two weeks of January or on major local holidays. If you are unable to take the Step within your eligibility period, you may request a one-time, three-month extension. A $50 fee is charged for this service. Use the Eligibility Period Extension Form available at www.nbme.org. If you do not take the Step within your eligibility period or extension and wish to take it in the future, you must submit a new application and fee.

Item 4 Name: At the test center, you must present an unexpired, governmentissued form of identification that includes both your photo and signature, such as a current drivers license or passport. Enter your name exactly as it appears on the identification you plan to use at the test center. If you have applied previously under another name for any NBME Part or USMLE Step and have not requested a name change on the official NBME record, please provide your previous name and enclose two documents: a certified copy of the official document which verifies the change (e.g., marriage certificate or court order) and a copy of a document bearing your current signature, photo, and other identifying information (e.g., drivers license). Item 5 US Social Security and National Identification Numbers: Enter your US SSN and/or your NIN, the official number assigned by your country if outside the United States. Enter the NIN-issuing country as well. Item 6 Fee The exam fee is $420. Enter the amount of your payment. Make your check or money order payable to the NBME in US currency. Write the exam name, your name, and your US Social Security or National Identification Number on your check or money order. This fee is nonrefundable and must be submitted with your application. Fees are not transferable from one application to another. The exam is available in many locations outside the United States and Canada at additional cost; international test delivery surcharges vary from region to region. For information about testing at an international center and region surcharges, contact the NBME at (215) 590-9700 between 8 am and 5 pm eastern time. Item 7 Date of Birth/Gender: Complete this item. Item 8 Medical School Information: Enter your medical school code from the list on pp 3-5 and complete the rest of this item. Enter your name and Social Security Number or National Identification Number at the top of page 2, and check the box for the Step for which you are applying.

Item 9 Previous Medical School History: Complete this item if applicable. Item 10 Address: Enter your current mailing address. The address you enter here will be used for communication regarding registration for this exam. If your address changes after you submit your application, use the Address Change Authorization Form on the USMLE page of the NBME website at www.nbme.org. Item 11 Citizenship Upon Entering Medical School: Complete this item. Item 12 Test Accommodations: Check this box if you are requesting test accommodations. You must have a documented disability and must be covered under the Americans with Disabilities Act (ADA). For further instructions, go to the USMLE page on the NBME website at www.nbme.org. Item 13 Optional Information: Completing this section is voluntary. We encourage you to provide this information which will be used for research purposes only. The processing of your application will not be affected by your choice in this regard. Item 14 Identification: Complete the top section of this item. Securely tape or glue a recent photo to your application where indicated. (Do not staple or clip.)

Certification of Identification: - Section A: If you are a medical student and have not graduated, the signature of an authorized official of your medical school is required here. The impression of the school seal must be partly upon your photo. - Section B: If you are a medical school graduate, a notary public or a commissioner of oaths must sign here. The impression of the notary seal must be partly upon your photo.

Item 15 Signature: Review the 2003 USMLE Bulletin of Information and read this statement carefully before signing it. If you are a medical school graduate, you must sign your application in the presence of the notary/commissioner of oaths who completes Section B under Certification of Identification above.

If your application is not complete, signed, and certified as instructed, or if your fee is not enclosed, your registration will be delayed. You will receive a letter requesting immediate attention to this matter.

MAILING YOUR APPLICATION Mail your application and fee via first-class mail or via an express or overnight carrier service as follows: First-class mail address: National Board of Medical Examiners P.O. Box 48010 Newark, NJ 07101-4810 Overnight carrier service address: National Board of Medical Examiners - 48010 c/o Image-Remit, Inc. 205 North Center Drive Commerce Center - Suite 205 North Brunswick, NJ 08902

Do not mail your application materials and fee to the NBME Market Street address.

YOUR SCHEDULING PERMIT

Your Scheduling Permit with instructions for making an appointment at a Prometric Test Center will be mailed to you after your application is processed and your eligibility is determined. Your permit will not be sent more than six months before your eligibility period begins.

You will be able to schedule your exam when you receive your Scheduling Permit. You will not be able to take the exam if you do not bring your official Scheduling Permit to the test center.

NAME CHANGE

If your name changes after you submit your application, use the Name Change Authorization Form on the USMLE page of the NBME website at www.nbme.org. Telephone calls, faxes or e-mails are not accepted for this purpose.

An addendum to your Scheduling Permit will be sent to you. It will contain your new name. You must bring both your addendum and Scheduling Permit to be admitted to the exam. The name on your unexpired, government-issued photo identification that you are required to present at the test center must match exactly the new name on your addendum.

For information about your Scheduling Permit, scheduling/rescheduling your exam, scheduling a practice session, testing at a Prometric center, or score reporting, review the 2003 USMLE Bulletin of Information at www.usmle.org.

MEDICAL SCHOOL CODE LIST - ALPHABETICAL BY STATE Use for Item 8, Medical School Information. UNITED STATES AND TERRITORIES Alabama 001-010 Alabama 001-020 South Alabama Arizona 003-010 Arizona California 005-010 California - Davis 005-020 California - Irvine 005-030 California - Los Angeles 005-031 California - Los Angeles (Drew) 005-032 California - Los Angeles (Riverside) 005-040 California - San Diego 005-050 California - San Francisco 005-060 Loma Linda 005-080 Southern California 005-090 Stanford 005-150 Touro Univ. College of Osteopathic Medicine 005-070 Western Univ. of Health Sciences/ College of Osteopathic Medicine of the Pacific 3

Arkansas 004-010 Arkansas

Colorado 006-010 Colorado Connecticut 007-010 Connecticut 007-020 Yale District of Columbia 009-010 George Washington 009-020 Georgetown 009-030 Howard Florida 010-010 010-020 010-040 010-030 Georgia 011-010 011-020 011-030 011-040 Hawaii 012-010 Illinois 014-020 014-030 014-040 014-041 014-042 014-043 014-050 014-011 014-010 014-060 014-070 014-080 Indiana 015-011 015-012 015-013 015-014 015-010 015-015 015-016 015-017 015-018 Iowa 016-010 016-020 Kansas 017-010 017-011 Florida Miami Nova Southeastern University/ College of Osteopathic Medicine South Florida Emory Medical College of Georgia Mercer Morehouse Hawaii Chicago Medical School Chicago - Pritzker Illinois - Chicago Illinois - Peoria Illinois - Rockford Illinois - Urbana Loyola Midwestern University - Glendale AZ Midwestern University - Downers Grove Northwestern Rush Southern Illinois Indiana - Bloomington Indiana - Evansville Indiana - Fort Wayne Indiana - Gary Indiana - Indianapolis Indiana - Muncie Indiana - South Bend Indiana - Terre Haute Indiana - West Lafayette Iowa Des Moines University Osteopathic Medical Center Kansas - Kansas City Kansas - Wichita

Maine 020-010

University of New England/Osteopathic Medicine

Maryland 021-010 Johns Hopkins 021-020 Maryland 021-030 Uniformed Services Massachusetts 022-010 Boston 022-020 Harvard 022-030 Massachusetts 022-040 Tufts Michigan 023-010 023-020 023-030 023-040 Michigan State Michigan State College of Osteopathic Medicine Michigan - Ann Arbor Wayne State

Minnesota 024-010 Mayo 024-020 Minnesota - Duluth 024-030 Minnesota - Minneapolis Mississippi 025-010 Mississippi Missouri 026-010 026-020 026-030 026-040 026-050 026-060 Kirksville College of Osteopathic Medicine Missouri - Columbia Missouri - Kansas City University of Health Sciences/ Osteopathic Medicine Saint Louis Washington University

Nebraska 028-010 Creighton 028-020 Nebraska Nevada 029-010 Nevada

New Hampshire 030-010 Dartmouth New Jersey 031-010 UMDNJ - New Jersey Medical School - Newark 031-020 UMDNJ - Osteopathic Medicine - Stratford 031-031 UMDNJ - Robert Wood Johnson - Camden 031-030 UMDNJ - Robert Wood Johnson - Piscataway New Mexico 032-010 New Mexico New York 033-010 Albany 033-020 Albert Einstein 033-030 Columbia 033-040 Cornell 033-050 Mount Sinai 033-060 New York College of Osteopathic Medicine 033-070 New York Medical College 033-080 New York University 033-090 Rochester 033-100 SUNY - Brooklyn 033-110 SUNY - Buffalo 033-120 SUNY - Stony Brook 033-130 SUNY - Syracuse 4

Kentucky 018-010 Kentucky 018-020 Louisville 018-050 Pikeville College/School of Osteopathic Medicine Louisiana 019-010 Louisiana - New Orleans 019-020 Louisiana - Shreveport 019-030 Tulane

North Carolina 034-020 Duke 034-030 East Carolina 034-040 North Carolina 034-010 Wake Forest North Dakota 035-010 North Dakota Ohio 036-010 036-020 036-030 036-040 036-050 036-060 036-070 Case Western Reserve Cincinnati Medical College of Ohio Northeastern Ohio Ohio State Ohio University College of Osteopathic Medicine Wright State

Utah 045-010

Utah

Vermont 046-010 Vermont Virginia 047-010 Eastern Virginia - Norfolk 047-020 Medical College of Virginia 047-030 Virginia - Charlottesville Washington 048-010 Washington - Seattle West Virginia 049-010 Marshall 049-020 West Virginia School of Osteopathic Medicine 049-030 West Virginia Wisconsin 050-010 Medical College of Wisconsin 050-020 Wisconsin - Madison CANADA Alberta 057-010 057-020 Alberta Calgary

Oklahoma 037-010 Oklahoma State University/Osteopathic Medicine 037-020 Oklahoma - Oklahoma City 037-021 Oklahoma - Tulsa Oregon 038-010 Oregon

Pennsylvania 039-010 Hahnemann 039-020 Jefferson 039-090 Lake Erie College of Osteopathic Medicine 039-100 Drexel 039-030 Medical College of Pennsylvania 039-040 Pennsylvania State 039-050 Pennsylvania 039-060 Philadelphia College of Osteopathic Medicine 039-070 Pittsburgh 039-080 Temple Puerto Rico 053-010 Central del Caribe 053-020 Ponce 053-030 Puerto Rico Rhode Island 040-010 Brown South Carolina 041-010 Medical University of South Carolina 041-020 South Carolina - Columbia South Dakota 042-010 South Dakota Tennessee 043-010 East Tennessee 043-020 Meharry 043-030 Tennessee 043-040 Vanderbilt Texas 044-010 044-030 044-020 044-040 044-050 044-060 044-070 044-080 Baylor North Texas Health Sciences Center Texas A & M Texas Tech Texas - Galveston Texas - Houston Texas - San Antonio Texas - Southwestern

British Columbia 058-010 British Columbia Manitoba 059-010 Manitoba Newfoundland 061-010 Memorial Nova Scotia 062-010 Dalhousie Ontario 063-010 063-020 063-030 063-040 063-050 Quebec 064-010 064-020 064-030 064-040 McMaster Ottawa Queens Toronto Western Ontario Laval McGill Montreal Sherbrooke

Saskatchewan 065-010 Saskatchewan

Refer to the Application Instructions when completing this form. Type or print in block letters. Use black ink only.

UNITED STATES MEDICAL LICENSING EXAMINATION (USMLE)

2003 Step 1 and Step 2 Application

for Students/Graduates of US/Canadian Medical Schools National Board of Medical Examiners (NBME) 3750 Market Street, Philadelphia, PA 19104-3190 (215) 590-9700 1. USMLE IDENTIFICATION NUMBER (if known) 2. EXAMINATION
Check one box only.

Step 1 Y

Step 2 Z 7. May 1, 2003 to July 31, 2003 8. June 1, 2003 to Aug. 31, 2003 9. July 1, 2003 to Sep. 30, 2003 10. Aug. 1, 2003 to Oct. 31, 2003 11. Sep. 1, 2003 to Nov. 30, 2003 12. Oct. 1, 2003 to Dec. 31, 2003

3. ELIGIBILITY PERIOD
Check the three-month period during which you wish to take the exam. Check one box only.

1. Nov. 1, 2002 to Jan. 31, 2003 2. Dec. 1, 2002 to Feb. 28, 2003 3. Jan. 1, 2003 to Mar. 31, 2003 4. Feb. 1, 2003 to Apr. 30, 2003 5. Mar. 1, 2003 to May 31, 2003 6. Apr. 1, 2003 to June 30, 2003

USMLE Steps 1 and 2 are not offered during the first two weeks of January or on major local holidays. 4. NAME
Print your name exactly as it appears on the identification you plan to present at the test center. See Instructions, Completing Your Application.

Last

First

Suffix (e.g., Jr, III)

Middle
If you have applied previously under another name for any NBME Part or USMLE Step and have not requested a name change on the official NBME record, please print your previous name below and enclose two documents: a certified copy of the official document which verifies the change (e.g., marriage certificate, court order) and a copy of a document bearing your current signature, photograph, and other identifying information (e.g., drivers license).

Last 5. US SOCIAL SECURITY AND NATIONAL IDENTIFICATION NUMBERS

Enter your SSN and/or your NIN, the official number assigned by your country if outside the US.

First

Middle

US Social Security Number

National Identification Number

Name of NIN-issuing Country 7. DATE OF BIRTH/GENDER

6. FEE
See Instructions for fee.

$ -

US DOLLARS

___ ___ / ___ ___ / ___ ___ ___ ___

Month Day Year

Male Female

8. MEDICAL SCHOOL INFORMATION

See Instructions for medical school code.

Medical Degree Expected/Conferred MD DO

Medical School Code

Are you participating in a combined medical degree/PhD program?

Name of Medical School

Yes

No

City Date Enrolled ___ ___ / ___ ___ ___ ___

Month Year

State/Province

Country

Date Medical Degree Expected/Conferred ___ ___ / ___ ___ ___ ___
Month Year

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2003 USMLE Step 1 and Step 2 Application - page 2

Last Name

First Name Check one:

Middle Name

Step 1

Step 2

SSN/NIN

9. PREVIOUS MEDICAL SCHOOL HISTORY

If applicable.

School Attended ___ ___ / ___ ___ ___ ___ to ___ ___ / ___ ___ ___ ___
Month Year Month Year

City 10. ADDRESS

Print your current mailing address. If your address changes, see Instructions, Completing Your Application. The address you enter here will be used for communication regarding registration for this examination.

State/Province Country

Dates Attended

Address Line 1/Apartment #

Address Line 2

Address Line 3

City

State/Province

Country

(
Zip/Postal Code 11. CITIZENSHIP UPON ENTERING MEDICAL SCHOOL 12. TEST ACCOMMODATIONS
Check this box if you are requesting test accommodations.

)
E-mail Address (please print and use proper case)

Daytime Telephone No.

USA

Canadian

Other (specify)

I have a documented disability and am covered under the Americans with Disabilities Act (ADA). I am requesting test accommodations. (Checking this box does not constitute an official request. You must submit your request for test accommodations and accompanying documentation at the same time as this application. See instructions at www.nbme.org) Provision of the following information is voluntary and will be used for research purposes only. You are encouraged to provide the information. The processing of your application will not be affected by your choice in this regard. Select the option or options which best describe your racial/ethnic background.

13. OPTIONAL INFORMATION

1. American Indian/Alaskan Native 2. Asian 3. Native Hawaiian/Other Pacific Islander 4. Hispanic or Latino
Is English your native language?
Yes No

5. Black or African American 6. White 7. Other

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2003 USMLE Step 1 and Step 2 Application - page 3

14. IDENTIFICATION

Check one:

Step 1

Step 2

Name ____________________________________________________________________________________________________________________________________________
Last First Middle

SSN/NIN __________________________________

Date of Birth ___ ___ / ___ ___ / ___ ___ ___ ___
Month Day Year

Gender

Male

Female

Name of Medical School _______________________________________________________________________________________________________________________________

CERTIFICATION OF IDENTIFICATION
A. For Applicants Currently Enrolled in Medical Schools - Certification by your Medical School is Required. I certify that the above-named individual is officially enrolled in the medical school named above, and that the photograph
Securely tape or glue in this square a current front-view 2 X 2 passport-type photo. (Print full name on back of photo before attaching.)

and signature entered on this form accurately apply to the individual.

School Officials Name _________________________ Signature _____________________________________

Title ___________________________________________________________ Date ___ ___ / ___ ___ / ___ ___ ___ ___
Month Day Year

B. For Applicants Who Are Medical School Graduates - Certification by Notary Public or Commissioner of Oaths is Required. State/Province of ____________________________________ County of ________________________________________ I certify that on the date set forth below the individual named 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 the applicants signature below made in my presThe impression of the seal must be partly upon the photo.

SEAL

ence on this form with the signature on his/her identifying document. The statements on this document are subscribed and sworn to before me by the applicant on this _____ day of __________________ , ___ ___ ___ ___ . Notary Public/Commissioner of Oaths Signature ________________________________________________________________________________ Expiration Date ___ ___ / ___ ___ / ___ ___ ___ ___
Month Day Year

15. SIGNATURE I certify that I currrently meet the USMLE Step 1 and Step 2 eligibility requirements and that the information provided on this form is true and accurate. I also certify that I have read the 2003 USMLE Bulletin of Information and the Application Instructions, am familiar with their contents, and agree to abide by the policies and procedures described therein.

Applicant Signature _______________________________________________________________________________

Date

___ ___ / ___ ___ / ___ ___ ___ ___

Month Day Year

Mail your completed application and fee, made payable to the NBME in US currency:

via first-class mail to: National Board of Medical Examiners P.O. Box 48010 Newark, NJ 07101-4810

or

via express or overnight delivery service to: National Board of Medical Examiners-48010 c/o Image-Remit, Inc. 205 North Center Drive Commerce Center - Suite 205 North Brunswick, NJ 08902