How to sign up for and schedule the USMLE

Step by step

1. Read the USMLE Bulletin of Information for the year of your eligibility period.
2. Check you’re eligible. For Step 3 you must have passed Step 1 and Step 2 CK and have your medical degree, plus ECFMG Certification if you trained outside the U.S.
3. Apply: MyUSMLE (NBME) for LCME- or COCA-accredited U.S. schools, or the FSMB USMLE portal for schools outside the U.S.
4. Pick your eligibility period and pay the fee. Ask for any test accommodations at the same time.
5. Wait for your scheduling permit by email.
6. Book your date on the Prometric website. Do it early, because popular centers fill up.

If you trained outside the U.S.

Since January 12, 2026, FSMB handles USMLE registration for international medical students and graduates. That includes Step 1 and Step 2 CK, which used to go through ECFMG. FSMB also handles eligibility extensions, testing region changes and score reports.

ECFMG still decides whether you’re eligible and still issues ECFMG Certification. You use MyIntealth to apply for certification and send your medical education documents. For certification you need to pass Step 1 and Step 2 CK and meet a clinical and communication skills requirement, which currently includes a satisfactory OET Medicine score.

Rescheduling

You can reschedule with Prometric, as long as the new date is inside your eligibility period. You’ll need your Prometric confirmation number. Changes 46 or more days before your test are free. After that, fees start at $35 and rise to as much as $317 for Step 3 changes made 5 days or less before your test.

Can’t test in your eligibility period? Ask the organization that registered you for a one-time extension of three months. There’s a fee. If you miss both periods, you have to apply and pay again.

Test accommodations and extra break time

If you have a documented disability, you can ask for accommodations under the ADA. You can also ask for extra break time only, for example for diabetes or to express milk. Tick the test accommodations option on your Step application. That puts a temporary hold on your scheduling permit. Then send the request and your documents through the MyUSMLE portal.

Decisions take about 60 business days and can’t be sped up, so apply early. USMLE’s own example: for a June to August eligibility period, send it by early March. Common items like glasses, inhalers, insulin pens and a glucose monitor are pre-approved and don’t need a request. Questions go to NBME Disability Services at disabilityservices@nbme.org or 215-590-9700.

Testing dates are changing in 2029

Right now you can book any open date in your eligibility period. USMLE plans to move to a limited set of designated testing dates each year, starting in January 2029. The details on applying and scheduling aren’t final yet, so check usmle.org if you’ll be testing then.