FCVS
		P.O. Box 619850
		Dallas, TX 75261-9850

• Affidavit and Release Form - 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. 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 - To explain 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.

		FCVS
		P.O. Box 970900
		Dallas, TX 75397-0900

• Profile Designation Form
• Profile Designation Change Form - To designate or change the recipient of your Physician Assistant Information Profile.

For your convenience, FedEx Office (formerly FedEx Kinko's) offers discounted services to FCVS applicants, including photocopies and passport quality photographs. Most of the documentation that you will be requested to send to FCVS can be taken to your local FedEx Office location for one-stop shopping at a greatly reduced cost. Notary services are also available, regular fees apply. Simply present Preferred Customer number 8400051717 at your local FedEx Office location. To find your nearest FedEx Office location, click here.