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Use this form only if you are a graduate of a non-LCME-accredited medical school located in one country but completed one or more clinical clerkships in another country.

Please Note: This form must be mailed directly to the Office of the Professions by the hospital in its identifying envelope. We will not accept this form if it is submitted by the applicant or a third party.

The New York State Education Department has approved specific schools to allow students to complete more than 12 weeks of clinical clerkships in New York State. A list of these schools can be found here. Form 2CC is not needed for those graduates who completed all clerkships after the approval date listed. Note: Form 2CC is required for any clerkships completed prior to that approval date.

Former students of CIFAS, CETEC, and UTESA should not use Form 2CC. These applicants should request special clerkship verification forms from the Office of the Professions, Bureau of Comparative Education at (518) 474-3817 ext. 300 or by e-mail at

  • Section I: Complete this section of the form before sending it to the hospital where you completed your clinical clerkship.
  • Section II: The Director of Medical Education or Department Chair must complete this section and return the form directly to the Office of the Professions at the address on the form.

Please make as many copies of Form 2CC as needed.