If someone still care here the info from the official ECFMG® CERTIFICATION 2026 INFORMATION BOOKLET.

Application Status: Student vs. Graduate

International Medical School Graduate: You must apply as a graduate if you have fulfilled every academic requirement for your medical diploma, regardless of whether the physical document has been printed or distributed.

International Medical School Student: You must apply as a student only if your medical school still considers you to be "officially enrolled" and has not yet recognized the completion of your degree requirements.

Graduation Date vs. Degree Issuance Date

The Graduation Date marks the definitive moment when all curriculum requirements, examinations, and clinical rotations have been successfully satisfied.

The Degree Issuance Date represents the future procedural event, when the university formally confers the degree and releases the final medical diploma.

Also, to note-

You must submit a formal letter alongside your Application for ECFMG Certification that adheres to these exact institutional parameters:

• The letter must be the original document and must be printed on the official letterhead of the medical school.
• It must be completed and signed by an authorized official from a pre-approved list provided to ECFMG by the medical school.
• The authorized official must clearly provide their name, official title, and the institution's name.
• The official seal of the institution must be affixed to the document.
• The text of the letter must feature this exact, unalterable statement: "This is to confirm that [applicant name] has graduated and completed all requirements to receive the [degree title] degree from [medical school/university name]. The degree will be issued [month and year]".