2027 Match Worksheet

1

Account Information

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First name*Middle nameLast name*SuffixGender*Email*Birth date*I authorize the release of my birth date to programs.

2

Basic Information

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Previous last namePreferred namePreferred pronounPreferred phone*Mobile phoneAlternate phone

3

Address

Stays on this device

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Current mailing address

Address 1*

Address 2

Country*State

Required for U.S. & Canadian addresses

City*Postal code

My permanent address is the same as my current mailing address

Permanent address

Address 1

Address 2

CountryStateCityPostal code

4

Work Authorization

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Are you currently authorized to work in the United States?*

What is your current work authorization?

Will you need visa sponsorship to complete the entirety of your GME training?*

Current state/province of residence (U.S. or Canada)

5

Match Information

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I plan to participate in the NRMP Match

NRMP ID

Register separately at nrmp.org. Worksheet does not register you.

Participating as a couple in NRMP?

AUA member number (Urology Match)

6

Identification Numbers

All stay on this device

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USMLE / ECFMG IDNBOME ID

Required for D.O. applicants

AOA member number

7

Language Fluency

See MyERAS for the proficiency-level definitions (Native, Advanced, Good, Fair, Basic).

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Do you meet or exceed the Advanced level of proficiency in English?

Other languages where you meet or exceed Good proficiency

Comma-separate. e.g., Spanish, Hindi, Tagalog

8

Military Information

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Are you committed to fulfill a U.S. military active duty service obligation/deferment?*

Other service obligations (reserves, public health/state programs)?*

9

Hometowns

Up to three areas where you currently or previously lived and feel strong ties.

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Entry 1

Country*State / ProvinceCity*Postal codeSetting

Entry 2

CountryState / ProvinceCityPostal codeSetting

Entry 3

CountryState / ProvinceCityPostal codeSetting

10

Geographic Preferences

Up to three U.S. Census divisions. Skip the section to send no info to programs.

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Entry 1

U.S. Census division

Describe your preference (or lack of)0/300

Entry 2

U.S. Census division

Describe your preference (or lack of)0/300

Entry 3

U.S. Census division

Describe your preference (or lack of)0/300

11

Setting Preferences

Urban / suburban / rural preference (or lack of preference).

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Setting preference

Describe your setting preference (or lack of)0/300

12

Higher Education

Undergrad and graduate schools. Most non-U.S. educational systems should indicate 'None.'

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Entry 1

Institution*Location*Education type*

e.g., Bachelor of Science, Master of Public Health

Field(s) of study*Degree expected or earned?*DegreeDegree monthDegree yearFrom monthFrom yearTo monthTo year

Entry 2

Institution*Location*Education type*

e.g., Bachelor of Science, Master of Public Health

Field(s) of study*Degree expected or earned?*DegreeDegree monthDegree yearFrom monthFrom yearTo monthTo year

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Medical Education

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Country*Institution*Degree*

e.g., MD, DO, MBBS

Degree month*Degree year*From month*From year*To month*To year*

✓

Postgraduate Training

For graduate applicants only. Add an entry for each prior or current training.

Done

None — I have no prior or current postgraduate training to report

15

Academic / Professional Interruptions

Not intended to solicit information about your health, disability, or family status.

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Any academic extensions, leaves, gaps, or breaks due to repeated/remediated coursework?*

Any professional extensions due to professionalism sanctions or other adverse actions?*

16

Honors & Awards

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Alpha Omega Alpha (AOA) statusGold Humanism Honor SocietySigma Sigma Phi (D.O. only)

Other honors / awards

Honor #1 typeNameDescriptionDate received

Honor #2 typeNameDescriptionDate received

Honor #3 typeNameDescriptionDate received

Honor #4 typeNameDescriptionDate received

Honor #5 typeNameDescriptionDate received

17

Professional Memberships

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Organization #1Organization #2Organization #3Organization #4Organization #5

18

Selected Experiences

Up to 10 experiences that communicate who you are and what's most important to you. Description: 750-character limit.

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19

Meaningful Experiences

Pick up to 3 of your 10 selected experiences and reflect on why each was meaningful. 300-character limit each.

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1 of 3 meaningful experiences

Experience title

Description0/300

2 of 3 meaningful experiences

Experience title

Description0/300

3 of 3 meaningful experiences

Experience title

Description0/300

20

Impactful Experiences

Optional. Challenges or hardships that influenced your journey to residency. 750-character limit.

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Describe (e.g., family / financial background, community setting, educational experiences, life circumstances)0/750

21

Hobbies & Interests

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Hobbies and interests0/300

22

Licenses & Certifications

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Entry 1

State*License type*License number*Expiration month*Expiration year*

Entry 2

State*License type*License number*Expiration month*Expiration year*

23

Additional Questions

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Are you able to carry out the responsibilities of a resident, intern, or fellow with or without reasonable accommodations?*

Has your medical license ever been suspended/revoked/voluntarily terminated?*

Have you been named in a malpractice case?*

Anything in your past that would limit your ability to be licensed or receive hospital privileges?*

Have you ever been convicted of a misdemeanor in the United States?*

Have you ever been convicted of a felony in the United States?*

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Board Certifications, Other Certifications & DEA

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Are you board certified?

Other medical / health-care related certifications?

DEA Registration

DEA registration numberExpiration monthExpiration year

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Scholarly Work

Up to 3 most meaningful entries. ERAS allows more — duplicate this section in MyERAS for additional works.

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Entry 1

Type*Publication status

Title*

255-character limit

Publication name / venue*

Authors*

Last Name, First Initial Middle Initial — comma-separated

First author?

DateVolumeIssuePages

e.g., 200-212

URLPMID

Entry 2

Type*Publication status

Title*

255-character limit

Publication name / venue*

Authors*

Last Name, First Initial Middle Initial — comma-separated

First author?

DateVolumeIssuePages

e.g., 200-212

URLPMID

Entry 3

Type*Publication status

Title*

255-character limit

Publication name / venue*

Authors*

Last Name, First Initial Middle Initial — comma-separated

First author?

DateVolumeIssuePages

e.g., 200-212

URLPMID

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Specialty-Specific Questions

Pick the specialties you're applying to. Only programs in those specialties will see your answer.

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27

Certification

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I certify that the information contained in this worksheet is complete and accurate to the best of my knowledge. All written passages, such as my personal statement and descriptions of work/activities, are my own. I might use mentors, peers, and/or AI tools for brainstorming, proofreading, or editing, but my final submission represents my own work and accurately reflects my experiences.

I certify the above