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Your FPGEC and ECE Application
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Your FPGEC and ECE Application
FPGECAttestation(Application submitted after 1/1/2020)
IherebycertifythattheinformationIhaveprovidedtoNABPrelatedtothisAttestationistrue,accurate,andcompletetothebest
ofmyknowledge,andthatIhaveenclosedarecentphotographofmyselfconsistentwiththerequirementsintheForeign
PharmacyGraduateEducationCommittee(FPGEC)CandidateApplicationBulletin(Bulletin).
IherebyacknowledgethatthisAttestationispartofmyFPGECapplication.
IagreetoseparatelysubmitthefollowingFPGECapplicationdocumentsasfurtherdescribedintheBulletin:
1. AnonlineFPGECapplication;
2. Acopyofmylicenseand/orregistrationfromthecountrywhereIamcurrentlylicensed;and
3. AnapplicationandrequiredfeestoEducationalCredentialEvaluators(ECE).
4. A non-expired, passing Test of English as a Foreign Language Internet-based Test (TOEFL iBT) score report.
IacknowledgethatifIdonottimelysubmitacompleteFPGECapplication,NABPmayclosemyFPGECapplicationwithoutissuinga
refund.IfNABPclosesmyFPGECapplicationbecauseitisincompleteandIstillwishtoachieveFPGECcertification,Iacknowledge
thatwillhavetosubmitanew,completeFPGECapplicationandpaythethenapplicableapplicationfee.PleaseseetheBulletinfor
furtherdetails.
IherebycertifythatIhavenotandwillnotengageinanyprohibite
dactivitiesormisconductasdescribedinthisAttestation,the
onlineapplication,ortheBulletin,suchasfraudorcheating,relatedtomyFPGECapplication,theFPGECCertificationprogram,or
FPGEE.
IherebyauthorizeNABPtosharewithpharmacyregulatoryorlawenforcementauthorities
anyinformationregardingmyFPGECapplication,includingthisAttestationandphotograph(s),
myparticipationinordisqualificationfromtheFPGECCertificationprogram,ormyTOEFLiBT
orFPGEEtest(s)including,withoutlimitation,scores,status,ormisconduct.
IfurtherauthorizetheFPGECtoprovideanyinformationrelatedto
myFPGECapplication,
includingthisAttestationandphotograph(s),orinformationthatmayotherwisebecomeavailable
totheFPGEC,toanyorganizationorindividualwhomayassistNABPinreviewingmyFPGEC
application,evaluatingthevalidityofFPGECapplication‐relatedinformation,determiningmy
eligibilityforFPGECCertification,orwhohasorhadarelationshiporconnectiontomeand,inthe
reasonablejudgmentoftheFPGEC,mayhavealegitimateinterestinsuchinformationincluding,
withoutlimitation,aschoolofpharmacythatIattendedoratestingorganizationthatadministered
atesttomethatisrequiredbytheFPGECCertificationprogram.
IherebyattestthatIreadthisAttestationandtheBulletinandIherebyagreewiththeirterms
andrequirements.
IfurtherattestthatIhaveand,tothebestofmyabilitywillcontinueto,complywiththeAttestationandBulletintermsand
requirements.
Applicant must print and sign his/her full name in English on the first lines below, using black or blue ink, but only in the
presence of one of the following individuals: a Notary Public, Consular Official, or First-Class Magistrate.
______________________________________________
S
ignatureofApplicant
____________________________________________
Full Name (in black or blue pen)
The following is to be completed by a Notary Public, Consular Official, or First-Class Magistrate in English:
Subscribedandswornto(oraffirmed)beforemethis_______________dayof___________________, 20________.
SignatureofNotaryPublic,ConsularOfficial,orFirst‐ClassMagistrate:
____________________________________________________OfficialTitle__________________________________
Ifofficialtitleand/orsealisnotinEnglish,FPGECrequiresanofficialtranslation.Alterations or erasures of any kind on this page
will void the Attestation.
ATTACHONEPHOTOGRAPH
HERE
Use glue or tape to attach
the photo. DO NOT STAPLE
Oneadditionalidentical
photographmust
accompanythisapplication.
Seal,stamp,orsignatureof
officialmustcoveraportion
oftheattachedphotograph
andtheapplication.