Application for ECFMG Certification Information

IMPORTANT NOTE: THIS IS FOR YOUR RECORDS ONLY. DO NOT MAIL TO ECFMG.

Submit Date : 06 Dec 2019

Last Name(s) : Janeva
(Surname/Family Name)

Rest of Name : Elena Jovanovska

(First Name/Middle Name)

Date of Birth : 09 Jul 1981

Gender : Female
E-mail Address : eli.janeva@yahoo.com
Medical Education Status : GRADUATE
I confirm that I have graduated from medical school.
I confirm that the medical school from which I graduated is listed
in the World Directory of Medical Schools (World Directory) as
meeting eligibility requirements for its students and graduates to
apply to ECFMG for ECFMG Certification and
examination and that my graduation year is included in the
"Graduation Years" listed in the ECFMG note on the Sponsor
Notes tab of my medical school's World Directory listing.
Certification by Applicant
ECFMG Certification
I understand that,

 ECFMG, through its program of certification, assesses whether international

medical graduates are ready to enter residency or fellowship programs in the
United States that are accredited by the Accreditation Council for Graduate
Medical Education (ACGME). The ACGME requires international medical
graduates who enter such programs to be certified by ECFMG.
 ECFMG Certification assures directors of ACGME-accredited residency and
fellowship programs, and the people of the United States, that international
medical graduates have met minimum standards of eligibility to enter such
programs. ECFMG Certification does not, however, guarantee that these
graduates will be accepted into programs; the number of applicants each year
exceeds the number of available positions.
 ECFMG Certification is one of the eligibility requirements for international
medical graduates to take Step 3 of the three-step United States Medical
Licensing Examination (USMLE).
 Medical licensing authorities in the United States require that international
medical graduates be certified by ECFMG, among other requirements, to obtain
an unrestricted license to practice medicine.
 The Standard ECFMG Certificate and any and all copies thereof remain the
property of ECFMG and must be returned to ECFMG if the certificate is
 revoked or if ECFMG determines that the holder of the Certificate was not
eligible to receive it or that it was otherwise issued in error.
 All actions or attempted actions on the part of applicants, examinees, potential
applicants; others when solicited by an applicant and/or examinee; or any other
person that would or could subvert the examination, certification or other
processes, programs, or services of ECFMG are considered irregular behavior.
ECFMG may report a determination of irregular behavior to the USMLE
Committee for Individualized Review, Federation of State Medical Boards of
the United States, U.S. state and international medical licensing authorities,
graduate medical education programs, and to any other organization or
individual who, in the judgment of ECFMG, has a legitimate interest in such
information. Applicants should review and be familiar with the Policies and
Procedures Regarding Irregular Behavior.
 ECFMG will not provide services of any kind if doing so would be considered
violative of any applicable international, federal, state, or local laws or
regulations. Additionally, ECFMG may delay or suspend provision of services
while investigating whether the services or surrounding circumstances violate
such laws, regulations, or ECFMG's policies and procedures.

Confirm that I have read and understood the above: Yes

Release of Legal Claims, Waiver of Liability, Indemnification, and Hold Harmless
Statement
I hereby release ECFMG, its Board of Trustees, officers, directors, employees,
committees, and the agents of each of them (collectively, "ECFMG") of and from any
and all liabilities, complaints, claims, lawsuits, damages, demands, losses and expenses,
arising out of or in connection with any action or omission by ECFMG in connection
with this application, the application process, any investigation of my credentials and
documents, any investigation or finding of irregular behavior, examinations taken by
me through ECFMG (including the grading relating thereto), any failure or refusal to
issue me any certification, the revocation of any certification, any demand for forfeiture
or redelivery of such certificate, or any other related activities involving ECFMG
(collectively, "Claims") whatsoever I may have, now and in the future, in consideration
for the opportunity to apply through ECFMG for certification. I also hereby agree to
indemnify and hold harmless ECFMG with respect to any and all Claims (including
ECFMG's reasonable attorneys' fees). I understand that the decision as to whether I
qualify for ECFMG Certification rests solely and exclusively with ECFMG and that
ECFMG's decision-making authority is ongoing. I HAVE READ AND I
UNDERSTAND THIS RELEASE OF LEGAL CLAIMS, WAIVER OF LIABILITY,
INDEMNIFICATION, AND HOLD HARMLESS STATEMENT, AND I INTEND
TO BE LEGALLY BOUND BY IT.
Confirm that I have read, understood, and agree to the Release of Legal Claims, Waiver
of Liability, Indemnification, and Hold Harmless Statement as described above: Yes
Release of Information Authorization
I request and authorize every person, medical school, university, hospital, government
agency, or other entity to release information to ECFMG bearing on the content of my
application or any other document submitted to ECFMG including, but not limited to,
records, diplomas, transcripts, and other documents concerning my identity, citizenship
or immigration status, educational, academic or professional history and status, or
enrollment.

I hereby authorize ECFMG to transmit any information in its possession, or that may
otherwise become available to ECFMG, bearing on the content of my application or
any other document submitted to ECFMG, including, but not limited to, records,
diplomas, transcripts, and other documents concerning my identity, citizenship or
immigration status, educational, academic or professional history and status, or
enrollment, and determinations of irregular behavior, to any federal, state, or local
governmental department or agency, to any hospital or to any other organization or
individual who, in the judgment of ECFMG, has a legitimate interest in such
information.
Confirm that I have read, understood, and agree to the Release of Information
Authorization as described above: Yes
Privacy Notice
Information regarding how ECFMG may collect, use, and disclose my personal
information in connection with the programs and services offered by ECFMG is set
forth in ECFMG’s Privacy Notice and is available on the ECFMG website
at https://www.ecfmg.org/annc/privacy.html.
Certify that I have read, understood, and agree to the ECFMG Privacy Notice: Yes
Certification
Certify that the information in this Application for ECFMG Certification was provided
solely by me, is true and accurate to the best of my knowledge; and certify that I have
read, understood, and agree to all of the above statements: Yes