Applicant Request for Waiver or Deferral

Applicant Request

Waiver or Deferral

NOTE: You are required to notify your matched program director of your request and the rationale. If you have not yet done so, STOP and inform your matched program director that you will be submitting a request.

Tell us about yourself:

Name(Required)

First Last

Email(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Cell Phone Number

By providing your cell phone number you agree the NRMP may call or text regarding your case.

NRMP ID(Required)

AAMC ID

Tell us about your matched program:

In which Match did you participate?(Required)

Did you obtain this position through SOAP?(Required)

In which SMS Match did you participate?(Required)

What year are/were you scheduled to begin training in the program?(Required)

What is the name of your specialty?(Required)

What is the NRMP Program Code?

What is the name of the institution/hospital?(Required)

Program Director Name(Required)

First Last

Program Director Email

Tell us about your request:

Are you requesting a waiver or deferral?(Required)

A waiver releases you and the program from the binding match commitment; a deferral is a one-year delayed start of training. A deferral MUST be agreed to by both parties.

Why are you requesting a waiver? (Categorical and Preliminary positions do NOT qualify for Change of Specialty)(Required)

Why are you requesting a deferral?(Required)

Please provide a detailed explanation for your request:(Required)

Please include all relevant information, context, and applicable timelines necessary for the NRMP to understand the situation.

If your waiver is approved, what are your plans for the upcoming year?(Required)

If your waiver is denied, will you honor your binding commitment regardless of the NRMP's decision?(Required)

PLEASE NOTE: Choosing “NO” indicates that you will not honor the binding commitment regardless of the waiver outcome. Once confirmed, the NRMP will release the matched program from the match commitment and continue separately with your waiver.

If your deferral is approved, what are your plans for the upcoming year?

Are you currently in a training program?(Required)

Select One

Please provide the following information about your current training program:

Specialty Name:(Required)

What is the NRMP Program Code?

Institution/Hospital Name(Required)

Current Program Director Name(Required)

First Last

Current Program Director Email Address

Terms and Conditions for NRMP Waiver/Deferral Request

By checking, you agree to the following:

Communication with Matched Program Director(Required)

You have notified your matched program of the waiver/deferral request.

Contact of Relevant Parties(Required)

The NRMP will review your request and contact your matched program director and all relevant parties.

Responsibility to Match Commitment during Waiver/Deferral Process(Required)

While the waiver/deferral request is under review, you may not seek, apply for, discuss, interview for, or accept a position in another training program. Doing so may result in a violation investigation.

Potential Outcome of Waiver/Deferral Process(Required)

If the waiver/deferral is not granted, you will be expected to honor your match commitment. Failure to do so may result in a violation investigation.

NRMP Decision of Waiver/Deferral(Required)

NRMP has sole discretion to grant or deny a requested waiver or deferral. NRMP’s decision is final and is not subject to challenge in arbitration, by judicial review, or by review of a third party.

Signature

By submitting this form, you are confirming that you wish to move forward with the waiver process. The NRMP will begin processing your request.

CAPTCHA

Please upload documentation to support your request – 3 file maximum

Drop files here or

Max. file size: 128 MB, Max. files: 3.

Once the NRMP receives your request, you will have the opportunity to submit additional documentation if necessary.

Please review all information carefully before submitting your request.

This field is for validation purposes and should be left unchanged.