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How to Extend Eligibility Period for the USMLE Step 1 (step-by-step)

This can be a confusing process. Everyone is saying one thing or another. I wrote this back in 2011 but updated it in October 2014. The same process works for Step 2 CK.

Let’s get started! First check you are not past the ECFMG processing deadlines. This link is also the official information page about extending your eligibility. If you continue reading this article, you will find a summary of my own experience as well as other students’ in the comments.

1. Cancel your exam with Prometric

After you cancel your exam, continue to the next step.

2. Send the application to extend your eligibility period


If you are a US or Canadian medical graduate your point of contact is the NBME. Login here. Click on the link to submit a new application. It will take you to the requirements page. At the bottom there is a link to a form which must be mailed.


Foreign medical graduates must login to ECFMG online services. The page after you login has a list titled Begin a New Application. Under there you will find the application appropriately named, “Request to Extend a USMLE Eligibility Period (EPEx) for Step 1”. Have your credit card handy because at the end you have to pay $65.

After all of this is done, you will be prompted to resubmit form 186 (certification of identification) if it has expired. If you sent the ECFMG your picture within the last 5 years you won’t be prompted to do it again.

Response Timeline (and how long it took for me to receive the response)

Email 1 (12 hours later): “Your Eligibility Period Extension (EPEx) request has been submitted to ECFMG. You will receive email confirmation when your request has been processed.”

Email 2 (1 day, 6 hours later): My eligibility period has been extended to (date). NBME will issue a new permit and the ECFMG will email it in about one week.

Note: Before you receive email 2, your school must approve your extension via the ECFMG Medical School Web Portal. If you don’t receive anything after a week, call your school! You may have to requalify for the exam.

Email 3 (3 days, 12 hours later): ECFMG emailed new permit. In the email they also included the following information:

“Important Note for Examinees who
-cancelled a testing appointment 30 or fewer days before their scheduled test date, or
-were turned away by the Prometric Test Center on their scheduled test date, or
-did not appear on their scheduled test date.

If you fall into one of these three categories and have not already called Prometric to pay an appointment change fee, your updated eligibility record failed to load into Prometric’s system. You will not be able to schedule a testing appointment until you call Prometric, as directed on your scheduling permit, and pay a fee to reinstate your eligibility record. After you have paid the appointment change fee, you must e-mail NBME at to notify the NBME that you have paid the appointment change fee. In your e-mail to NBME, you must
-type “Resend Eligibility” in the subject line, and
-type in the e-mail text that you have paid the appointment fee to Prometric. Include your full name, USMLE ID Number, examination type (Step 1 and/or Step 2 CK) and Testing Region in the e-mail text.

After receipt of the e-mail from you, the NBME will send your updated information to Prometric and respond to you within two business days. After you receive NBME’s response, you can then contact Prometric to reschedule your testing appointment. Please do not telephone the NBME.”

3. Now that you have your new permit…

If you cancelled your last appointment more than 30 days before your scheduled exam, there is no fee to pay, go study!

If it was less than or equal to 30 days before your exam, you need to pay a fee to Prometric before your eligibility record can be updated. Get ready to be on the phone for 20-30 minutes and dial 1-800-633-3926. The 2 minute recording will recommend using the website, but the only way to pay this fee is over the phone. Press 2 to “schedule an appointment”. You will be placed in the queue. When the agent comes on say, “I need to pay the appointment change fee to reinstate my eligibility for Step 1.”

Forward a copy of the receipt to Set the subject to “Resend Eligibility”. In the body, above the email you are forwarding, put:
Exam: Step 1
Testing Region: United States and Canada
I have included a copy of the receipt from Prometric for my appointment change fee. Thank you.”

I got a response three hours later saying my record has been updated. However, it may take up to 2 business days. To speed things up you could pay the appointment change fee after you receive the email saying your eligibility period has been extended.

4. Go back to working on the dream!

Go study now instead of saying you will start fresh tomorrow. Every time you learn something new, there is a benefit. Even if it is only one new concept. Unfortunately, it is easier said than done.

Sorry, comments are closed. All the answers are either provided on the ECFMG website, in the article above, or in the comments below. Please take the time to read through these resources. If you still can’t find the answer to your question, call the ECFMG (215-386-5900, M-F / 9-5 EST).

  1. hello,, iam a IMG, and my eligbility period is on oct-dec2014, and i want to extend it ,, note that i didnt choose a day of exam till now
    and iam a medical school graduate ,,,,
    so what should i do?

    • If you haven’t scheduled an appointment yet, jump to 2b. Send your application to extend your eligibility through ECFMG online services.

  2. Hi Hussein ,
    Thankyou for puting up such a helpful forum.
    Please clarify what to do in my case?
    My eligibility period was Oct-Nov-Dec 2014 , now I believe I ll have to extend it over Jan Feb march 2015 , I havn’t taken any appointment with the prometric centre as yet (today being Nov21st 2014.)

    When should I apply for an extension to pay the minimal fee ? How much would I have to pay if I apply now and how much do I have to pay if I apply in Dec ? (In both the cases Before taking any date with promwtric centre Ofcourse)

    • You are very welcome!

      The ECFMG fee would be the same in December as it is now.

      Thanks for your question. Best wishes for your exam.

  3. Hi Hussein, i just had a quick question, my original eligibility period was between June-Aug, which i extended to Sep-Nov due to personal problems. However 6 months are done, im not at the score i’d like to be in the practice exams. My question is if i reapply for the Step 1 say from dec-feb eligibility period:

    1) Will i have to reapply for form 186 or will the existing copy be used by ECFMG?
    2) I know i’ll have to repay the fees for re-applying but will this process be longer then before, is will the application processing time be shorter because they already have form 186?


    • Probably , u don’t have to resubmit your form 186.
      Once accepted, it is valid for 5 years.
      Just repay the fees and u will get rescheduling permit (need to cancel from prometric before u reschedule)

      Best luck.

    • Your help is greatly appreciated, Kevin, thank you.

      Joe, the same thing happened to me for Step 1! And you are right, it should be quicker to process. Make sure you are still qualified by your school. Too many times, myself included, we apply for extension or reapply for Step 1 and have to requalify by taking the comprehensive shelf again.

      Oh, and just to reiterate… Form 186 is good for 5 years!

      General update: I applied to extend my eligibility for Step 2 CK on Oct 31. It was approved on Nov 1 and I got the permit Nov 4. So the speed is largely dependent on how quickly your school approves your application. Also, I am currently on the road between NY to Cali, for an emergency medicine elective!

  4. Hi Hussein, thanks for your help with all the information above.

    Just wanted to clarify, I had initially scheduled my eligibility period for July-Aug-Sept but I’d like to extend this to Oct-Nov-December. The IWA website seems to be offline right now so I was wondering if you can answer my question. There are more than 5 days and less than 31 days to my exam date.

    I’ve heard that I have pay the exam feel of 900 something dollars all over again if I were to change my eligibility period, is this true?
    If not, do I just simply pay another fee or as Kevin said (might not be any fee)?

    Looking forward to your reply,


    • Yes, you can extend your eligibility period once for a small extension processing fee through IWA. If you do not take your exam during the extended eligibility period, you will have to re-apply for the exam and pay the full amount a second time.

      As per Kevin, he only had to pay ECFMG. He did not have to pay Prometric the appointment change fee. Ali, could you please confirm this once you are notified your extension has been approved? Thank you.

    • Hi,
      Sorry for late reply. i forgot to clarify this problem later on.
      Cancelling Appoinment is Free with prometric (You can cancel your appointment at anytime for free). However you will have to Reschedule exam and So Prometric will charge you 65 or 70$ at that time. So total – 65$ at ECFMG Site + 70$ to prometric when u want to Reschedule = 130$ in total….

    • Thanks, Kevin. I will update the article in a few days to clarify this!

    • no problem :)

  5. Hi Hussain,
    Thank you for this great article.
    But, I have question that remained –
    I initially – Send Eligibility Extension request via ECFMG & Paid $70.
    Then i called Prometric and cancelled my appointment ( 6 days before My Actual exam date)… & 1 thing that schoked me is that- they didn’t charged me anything and cancelled my appointment. i asked them about payment & they said “i don’t have to pay anything”. Then i asked for any confirmation email or like that , & said – no email will be sent about cancelling appointment.
    So , that’s all – now i should wait for my New Scheduling Permit (of Extended Period) from ECFMG ?
    Thank you buddy :)

    • Call them again tomorrow and tell the person on the phone you cancelled your appointment 6 days before your exam date and need to pay the cancellation fee to reset your registration so that you can extend your eligibility period. If they say you don’t have to pay anything then ask if their policy has changed recently, if not then ask to speak to a supervisor and explain the situation to them. Please feel free to update us with your findings. Best wishes!

    • I just received the following Message from ECFMG :

      “Dear Doctor:

      We have received your Interactive Web Application (IWA) Request to Extend a USMLE Eligibility Period. Your eligibility period for the Step 1 has been extended to September 30, 2014. Your testing region remains the same as stated in your original registration notice.

      In the near future, the National Board of Medical Examiners (NBME) will issue a new permit showing your extended eligibility period. Only electronic scheduling permits will be generated; applicants will access their electronic scheduling permits using ECFMG’s Interactive Web Application (IWA). You will not receive a paper permit by postal mail. Please note that in about one week you will receive another email from ECFMG to notify you that your new scheduling permit is available. Although this new permit will be issued by NBME, you should contact ECFMG if you have any questions or concerns about this permit.”

      So, i think there is no need to pay to Prometric. Will update you if anything..
      Thanks :)

  6. thank u for ur prompt reply

  7. hello..
    first of all, ur post is of a great help and relief to me….but i’d like to be clear a few things my exam period is may-june-july…i scheduled on may 22nd..however i can’t make it for some reasons and i will change the date which is within my original period, so i don’t need extension request,..but now it’s only 12 days i have to cancel and reschedule at prometric, right? out of curiosity, what if i don’t pay for that fee (50$?)? that means i can’t reschedule, only cancel? now my condition isn’t sure , i can’t cancel my exam…so i haven’t seen what if i won’t pay…my question may be silly, pls bear with me….and thank u very much..

    • I believe the website will request your credit card info when trying to rebook. I have changed the date for shelf exams before the deadline and at the bottom of the page it says something like amount due $0.00.

  8. As soon as you received your new scheduling permit, were you able to use it to schedule an appointment on prometric? Thanks.

    • You bet! I am currently studying for Step 2 CK and the content DOES get easier to digest.. Unfortunately, sitting down to study is as fun as it was for Step 1 – lol. Keep up the hard work!

  9. Hello Hussain!

    My eligibility period is ending this 30th. I was hoping to write the exam on 30th or the week after that. Is it possible to have the period extended and still be able to sit for the exam in the old eligibility triad?

    I just thought I’ll get over with the paper work of extension and have the liberty of writing the exam with peace of mind.

    • I do not know the answer to this. Could you please call the ECFMG and let us know what they say? Thanks!!

  10. First off, this page was a big help when I was trying to extend my eligibility period. Unfortunately, due to medical reasons, I need to further postpone my test date. I know that I will have redo the whole ecfmg application and pay the fee again when I take the test in the future.
    My questions is regarding how to deal with prometric in this case. I canceled my appointment online but it was within 30 days. Do I call them up now to pay the fee/e-mail nbme or should I wait until I have registered for the test again. I have not been able to set a date yet because I am unsure what my situation will be. Just trying to figure out if I should call/deal with them now or wait until I register for another testing period.


    • Hey Eric. Sorry for the delay in getting back to you. I am in the surgery rotation right now! Anyway, you already know you only get one extension for your eligibility period. If you do not take the exam during the extended eligibility period and instead reapply for Step 1, you will not need to pay a cancellation fee to Prometric. No matter when you cancel. You pay the examination fee ($580 now?) and book your new appointment.

  11. Just to clarify….If i do decide to cancel a month before my test date and not pay the fee, do I still need to call prometric or email NBME for anything? Or is just cancelling online sufficient?

    And then all I need to do is the ECFMG part and then they will give me a new scheduling number to register again with prometric, right?


    • If it is more than 31 days from your exam, cancel on prometrics website. Then logon to ECFMG’s IWA and complete the form to extend your eligibility, pay ECFMG’s $65 fee, print off any forms you need to mail, and call it a day.

  12. Hi…got a few questions.

    My exam is set for Dec. 30th (oct-dec period). I may want to postpone my test date if I do not feel ready closer to the date (is it ok that it will be during the next year?). Also,is there a limit as to how close to my scheduled test date that I can cancel with prometric (the fee is ok)?

    If I cancel my test online with prometric, I don’t understand if I have to/what is this e-mail we’re supposed to send to NBME. If you cancel and pay online with prometric, won’t they already know?

    Also, I can’t remember if I submitted a form 186 or 183 (what’s the difference?) to ecfmg when i first registered. I think I read somewhere that if it was a 183 I would need to submit it again for every application (or will it already be on file b/c I only did it a few months ago and this is just a postponement?). I am worried b/c that might take extra time and push me closer to the deadline for getting an extension.


    • Yes, it is okay that it will be next year. The important part is that it is the next 3 month period. As far as I know, you can cancel up to the day before.

      When I did this, Prometric didn’t offer a payment option for cancelled appointments on their website. If such an option is available now, forward the email receipt to the NBME.

      My understanding of IWA is that if you have to submit a form 183 or 186, it will notify you at the end of your application process. 186 is good for 5 years. 183 needs to be done for every application because those schools don’t use the ECFMG’s Medical School Portal. Here is an official link that compares the two:

  13. Hi, i have not booked any date with prometric yet. My eligibilty period is oct-dec ,but my problem is that my form 186 needs to go to my med school the second time.USMLE hasnt recieved the form yet from the school. The process of extending the eligibility period needs online aplicatiion plus Form 186.i dont know if i haveto wait for my form to reach usmle first then apply

    • Sara, if you want to extend it to after December you can use the online application. You only need to submit form 186 a second time if it has been more than 5 years since you submitted it the first time.

  14. Hi. I have my step 1 scheduled for november 4 but I want to reschedule the date for december. Do i have to call prometric to reschedule or can I reschedule and pay the fee through the prometric website? Thank U very much for your help!

    • If nothing has changed since I wrote this, you have to call Prometric and pay the fee if you want to reschedule less than 31 days before your exam during your eligibility period.

  15. Hey Hussein, Thank you for this article. It actually cleared up a lot of things for me.
    But I’m still so confused. my eligibility ends on october 31st and my exam is on october 31st. I’ve already extended my eligibility period once so i cant do that again. I would just have to reapply for another scheduling permit, correct? But before I do that, I have to call prometric and cancel over the phone? I see that there is an option to cancel on the prometric website. what is the difference between that and over the phone?
    I’m still so confused and so stressed. I almost wanna give up!

    This is what I thought the ECFMG person told me..
    1) Cancel my prometric date
    2) the earliest I can reapply for a scheduling permit is nov 15
    3) After that it would take 3 weeks to process that and then I’d get my new scheduling permit.

    Would this be counted as an incomplete attempt? would it affect me in the future?

    • You can cancel your appointment on the Prometric website. If you are more comfortable canceling over the phone you can do that too. As far as I know, it does not matter which way you do it. It will not be scored as incomplete. The delay may be something you get asked about during an interview one day. Other than that I don’t see it being much if a problem.

      Reapply for the exam using IWA. Before submitting your application, make sure you still qualify with your school to take the exam. They need to approve your application (behind the scenes) before you are issued a new scheduling permit.

      Keep studying!

  16. hi hussein.very nice article,just have a i still need to submit any 186 form,if i extend my eligibility,since i just submit my form 186 few months ago when i was getting registered for my step 1 for the first time?i mean they have it already my i dnt have to do it again ryt?

    • Thank you and yes, you are correct. From the EPEx Overview page, “Once accepted by ECFMG, Form 186 remains valid for five years.”

  17. pls hussein, i log on to my own ecfmg account and i cannot find extend your eligiblity period?

  18. Hi. I have the step 1 for september 18 and my window ends on september 30. I want to change my window for the next contiguous period. Do I have to cancel my appointment first with prometric and then submit the estension form to NBME? How do I cancel or reschedule with prometric? Thank you very much for your help.

    • Cancel your appointment using the Prometric website. After doing that call them and pay the fee. If you are an IMG, login to ECFMG’s IWA and submit the online form to extend your eligibility period. If you are a US grad, you extend through the NBME.

  19. Hi Hussain,
    Please clear my confusion, i have eligibility period Jun-August but i have not schedualed an appointment with prometric. Now i want to extend my eligibility period, what do i do now?
    Should i apply directly to ecfmg for the said extension paying only 65 $ or do i have to call prometric anyway?
    Please reply fast.

    • Skip prometric step since you do not have an appointment scheduled.

      Submit your application to extend your eligibility period to ECFMG and pay their $65 fee.

  20. Hi. My USMLE eligibility period in may-june-july. I scheduled my exam for 30th july but dont think i am prepared enough. I am planning to extend my eligibility period to the next slot. I still have >31 days before my scheduled test date. Can i get an extension from ECFMG and then reschedule my test date in the extended eligibility period without paying the 50$ (as i will do it 31 days before the test date) or does rescheduling in the next slot always involve payment?

    • 1. You will have to pay the extension application fee to ECFMG.
      2. You will not have to pay anything to Prometric if you cancel more than 31 days in advance.

      Best wishes for your exam!

  21. Thank you for this great post.
    Just to clarify some misunderstood concepts, so I :
    1- cancel my appointment first using the Prometric website
    2- I call Prometric for reinstating my eligibility period and pay the fees and send the e-mail to NBME (even though I am an IMG ? )
    3-I contact ECFMG to extend eligibility and wait for new scheduling permit and use that on prometric to schedule my new appointment ?

    And what happens if I request extension through ECFMG without reinstating my eligibility period with prometric first?

    Thank you very much

    • 1. Yes.
      2. Yes, call Prometric and forward the email to
      3. Yes. Login to IWA and submit the application for extending your eligibility period.
      4. I don’t know what will happen if you skip reinstating with Prometric.

  22. hey hussian i gt the mail 4m nbme just nw……reinstating my eligibity record on prometric site………nw i guess i just hav 2 wait 4 the new scheduling permit..THANKS HUSSIAN FOR UR GUIDANCE….ur post really been helpful….

  23. 1-contacted the prometric n payed the 50$ cancellation fee
    2-have send the receipt to didnt get ne mail)
    3-went to iwa n gt my eligibility extended(n gt the confirmation mail)

  24. hey i gt the mail 4m ecfmg but no response 4m nbme………should i resend the mail /wait…………..

    • Sorry, I do not know which email you are referring to. NBME does not ever send you an email if you are an IMG. Please write in proper English what steps you have completed.

  25. hey hussian ….u asked to send the permit num to nbme rt??…… tht the permit num on the previous scheduling permit issued…..n we dnt need to include the usmle id??

    • I received a response doing exactly what I wrote in this article. However, including your USMLE ID number is a good idea. It is an extra identifier that could be used if your permit number was incorrect.

  26. Hi I want to know if my eligibility period is in oct-December and my exam date is like 27th can I extend my eligibility period to next year consecutive 3 months like in dec-feb

    • Oct-Dec 2012 would be extended to Jan-Mar 2013. However, the deadline has passed to extend Oct-Dec eligibility.

  27. Thank you sooo very much! You saved me from a heart attack. I also accidentally submitted my ecfmg before contacting the prometric but your post cleared things up for me.
    Thank you so much again.

  28. I replied directly to cesar after reading his email. I forgot to add the answer here. If you have already extended once then you will need to reapply for the exam. Perhaps under very very special circumstances they would consider a second extension but you would have to call them to inquire about that. For most people, who do not feel confident enough to write the exam, there is no leeway in regards to this rule.

    By the way, I got my score 2 weeks ago, I passed!!

  29. hi, i’ve already asked for an extension (i supposed to have my test on the eligibly period of june-agost) and already got it untill november. But i need to ask for a new extension. Is it possible to ask for a new one?
    I would appreciated a fast answer, thank you very much!

  30. i called the prometric and paid my 50 dollars for which they gave me a receipt.
    i was told to dn send a mail to tellin them i had paid.i gt the followin mail an hour later


    Step 1 06/01/2012 – 11/30/2012

    Dear Dr. XXXXX:

    Thank you for contacting NBME to confirm that you paid the appointment change fee.

    Prometric reinstated your eligibility record, and I updated your eligibility period in their system. You may now go online or call Prometric to schedule a new appointment in your extended eligibility period using the Scheduling Number from your Scheduling Permit. Do not attempt to “reschedule” using your previous Prometric Confirmation Number, as that number is no longer valid.

    i guess i jut hav o wait for ecfmg to send me my permit!thank u hussain for the guidance

  31. i gt da foloowin response from ecfmg…
    Dear Doctor:

    We have received your Interactive Web Application (IWA) Request to Extend a USMLE Eligibility Period. Your eligibility period for the Step 1 has been extended to November 30, 2012. Your testing region remains the same as stated in your original registration notice.

    In the near future, the National Board of Medical Examiners (NBME) will issue a new permit showing your extended eligibility period. Only electronic scheduling permits will be generated; applicants will access their electronic scheduling permits using ECFMG’s Interactive Web Application (IWA). You will not receive a paper permit by postal mail. Please note that in about one week you will receive another email from ECFMG to notify you that your new scheduling permit is available. Although this new permit will be issued by NBME, you should contact ECFMG if you have any questions or concerns about this permit.

    You must bring this new permit and acceptable identification with you to the test center on the date of the exam.

    This new permit is very important, and you should be careful not to lose it. You cannot take the exam without this new permit. If you lose this new permit, you may print another one by using IWA. If the name on the permit is not correct, you must contact ECFMG immediately.

    Please refer to the ECFMG Information Booklet and USMLE Bulletin of Information for detailed information on scheduling your testing appointment and taking the exam. Both of these publications are available on the Publications page of the ECFMG web site at

  32. i havent goten any response until now…i guess ill have to wait until monday o call da prometric n ill keep updatin my status!

  33. I think they will email you and hold your application until the prometric portion is complete. Please note, I do not know what the outcome has been in the past for this situation.

  34. Hi mr hussein,

    i have a small problem.i applied for exension of eligibilty period first and paid 65dollars and then cancelled my appointment.i cant call the prometric now because its a weekend.what do i do now?will ecfmg reject my application for extension or wait unil i have contacted prometric and made the payment with them?

  35. HI, thanks for the guidance but i want to know that can i extend my elgibility period more than more than 90days/3months. eg my triad is 1st Apr to 30 June , can i extend it to 1st sep to 30 november ?

    • No. You can only extend your eligibility to the next continuous period.

  36. Hi, thank you so much for this! This is so far the best guide to a very confusing process (that I myself went through today). Thank you!

  37. Nice article. Simple and well written.

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