Application Process for Medical Certification

Applicant History
Item 3. Last Name; First Name; Middle Name

The applicant's legal last, first, and middle name* (or initial if appropriate) must be provided.

* If an applicant has no middle name, leave the middle name box blank. Do not use nomenclature which indicates no middle name (i.e. NMN, NMI, etc.). If the applicant has used such nomenclature on their MedXPress application, delete it and leave the middle name box blank.

Note: If the applicant's name changed for any reason, the current name is listed on the application and any former name(s) in the EXPLANATIONS box of Item 18 on the application.