FEDERATION CREDENTIALS VERIFICATION SERVICE (FCVS)

FCVS Physician Assistant Application
The FCVS application packet captures pertinent information in an efficient and easy-to-understand manner. Every application packet comes with comprehensive written instructions. Call our toll-free support line (1-888-ASK-FCVS) or email for assistance with completing an application. The verification process begins when the correctly completed application arrives at FCVS, with the appropriate fee.

New FCVS User
For those individuals who have not had FCVS verify their credentials.

• Initial FCVS Online Application
• Initial FCVS Paper Application
• US Virgin Islands Application

Retuning FCVS User
For those individuals who have established an FCVS profile.

• FCVS Online Subsequent Application
• FCVS Paper Subsequent Request

FCVS Physician Assistant Forms
The following forms are made available for the convenience of applicants. Please mail the forms listed below to the following address:

Federation Credentials Verification Service (FCVS)
Federation of State Medical Boards
400 Fuller Wiser Road, Suite 300
Euless, TX 76039

• Affidavit and Release Form: This form authorizes Federation Credentials Verification Service to release information, material, documents, orders or the like relating to me or this application to any entity at my request.
  • Complete this form and sign it in the presence of a notary.
  • Attach a recent (less than six months) 2" x 2" passport quality color photograph of yourself (alone) to this form in the designated space.
  • Photographs must be clear, front view, full face without a hat or dark glasses. Full-length photos, black and white or computer-generated photographs will not be accepted.
  • Sign your name across the bottom of the front of the photograph. Do not sign on the back of the photograph.
  • Be certain that the notary follows the directions listed on the form.

• Authorization and Release of Records Form: This form will be included with all correspondence to your source institutions. It gives permission to your source institutions to release documents, records and other information pertinent data to FCVS.
  • Complete the information requested and attach a recent (less than six months) 2" x 2" color photograph of yourself (alone) to this form in the designated space.
• Photographs must be clear, front view, full face without a hat or dark glasses. Full-length photos, black and white or computer-generated photographs will not be accepted.
• Sign your name across the bottom of the front of the photograph. Do not sign on the back of the photograph.
• Explanation of Alternate Name Form: This document explains the use of any name(s) not supported by the identity document(s) submitted with your application. Be certain to sign the form in the space provided at the bottom of the page.

An FCVS physician assistant application also can be obtained by calling toll-free 1-888-275-3287 or by email to fcvs@fsmb.org. FCVS requires the applicant's name and current address for processing the request. When requests are sent via email, confirmation will be sent when a request has been received. Applications may also be sent via email in an Adobe Acrobat format at your request. Make sure to specify whether an Initial Application or Subsequent Application Request is needed.

Please allow approximately five business days for an application packet to arrive. Overnight mail services are available through FedEx, and DHL; however, the individual's account number must be used. For your convenience, FedEx Office offers discounted services to FCVS applicants, including photocopies and passport quality photographs. Most of the documentation that you will need to send to FCVS can be taken to your local FedEx Office location for one-stop shopping at a reduced cost. Simply present Preferred Customer number 8400051717 at your local FedEx Office location.