EDUCATIONAL COMMISSION FOR 3624 Market Street

Philadelphia PA 19104-2685 USA

FOREIGN MEDICAL GRADUATES Phone: 215-966-3907
deansbox@ecfmg.org

AUTHORIZED SIGNATURE LIST (ASL) FOR

MEDICAL SCHOOL OFFICIALS

Medical School Name:

1. Important:
When evaluating an ECFMG form returned by a medical school, ECFMG must be able to confirm that the name, title, signature, and
seal on the form match exactly the name, title, signature, and seal on the ASL. ECFMG will reject any form if the information on the
form does not match exactly the information on the ASL.

PLEASE BE SURE TO KEEP A COPY OF THIS FORM FOR YOUR RECORDS AND REFERENCE THIS DOCUMENT
WHEN SIGNING ECFMG FORMS.

2. Official Medical School Seal(s): The appearance of the seal included here should match the seal applied to all ECFMG forms. Any
difference in the appearance of the seal, even if minor, will result in the rejection of the ECFMG form. Please include all of your medical school’s
official seals that will be used on ECFMG forms:

Seal #1 Seal # 2 Seal # 3

(If applicable) (If applicable)

3. Medical School Authorized Officials:

• Please provide the required information using an ink pen only. Please print clearly.
• Each medical school official authorized to sign ECFMG forms must provide his/her name, signature, and title exactly the
same way that he/she will write this information on all ECFMG forms. Any difference in the name (presentation/order),
signature or title, even if minor, will result in the rejection of the ECFMG form.
• Space is provided for each medical school official to include additional variations/formats of his/her name, title, and
signature as they will be used on ECFMG forms.

ECFMG ® is an organization committed to promoting excellence in international medical education.

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Medical School Official #1

KHALID JAVED RABBANI

Name (First/Middle/Last Name): _____________________________________________________________________________________________

Additional Name Format (if applicable):_______________________________________________________________________________________

PRINCIPAL
Job Title: _______________________________________________________________________________________________________________

Additional Job Title (if applicable): ___________________________________________________________________________________________

Signature: _______________________________________________________________________________________________________________

Additional Signature Format (if applicable): ____________________________________________________________________________________

principal@prcmdc.edu.pk
Email Address: ___________________________________________________________________________________________________________

Medical School Official #2 (if applicable)

JAVED IQBAL CHAUDHRY

Name (First/Middle/Last Name): _____________________________________________________________________________________________

Additional Name Format (if applicable):_______________________________________________________________________________________

DIRECTOR STUDENTS AFFAIRS

Job Title: _______________________________________________________________________________________________________________

PROFESSOR OF PHARMACOLOGY
Additional Job Title (if applicable): ___________________________________________________________________________________________

Signature: _______________________________________________________________________________________________________________

Additional Signature Format (if applicable): ____________________________________________________________________________________

director.sa@prcmdc.edu.pk
Email Address: ___________________________________________________________________________________________________________

Medical School Official #3 (if applicable)

SAIMA YOUNAS
Name (First/Middle/Last Name): _____________________________________________________________________________________________

Additional Name format (if applicable): _______________________________________________________________________________________

ASSISTANT MANAGER STUDENT AFFAIRS

Job Title: _______________________________________________________________________________________________________________

STUDENT COORDINATOR
Additional Job Title (if applicable): ___________________________________________________________________________________________

Signature: _______________________________________________________________________________________________________________

Additional Signature Format (if applicable): ____________________________________________________________________________________

studentscoordinatorprcmdc@gmail.com
Email Address: ___________________________________________________________________________________________________________

ECFMG ® is an organization committed to promoting excellence in international medical education.

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If you need to provide information for additional medical school officials, please provide this information on
your medical school’s letterhead and attach it to this ASL.

School address for mailing ECFMG verifications/forms: School main address (if different):

PAK RED CRESCENT MEDICAL & DENTAL

__________________________________________________ ____________________________________________________

COLLEGE, DINA NATH, 48 KM MULTAN ROAD,

__________________________________________________ ____________________________________________________

LAHORE, PAKISTAN
__________________________________________________ ____________________________________________________

+92 49 4540331
Medical school telephone number: ___________________________________________________________________________________________

http://prcmdc.edu.pk
Medical school website: ___________________________________________________________________________________________________

principal@prcmdc.edu.pk
Medical school email address: ________________________________________________________________________________________

ECFMG ® is an organization committed to promoting excellence in international medical education.

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