The journey towards regaining one's professional certification can often seem daunting, yet the Amt Reinstatement Form serves as a critical first step for individuals seeking to reclaim their credentials in the healthcare sector. Specifically designed for those who have previously earned certification as Medical Technologists (MT), Medical Laboratory Technicians (MLT), Registered Medical Assistants (RMA), Registered Dental Assistants (RDA), or several other allied health professions, this form is an essential tool for re-entry into professional practice. It meticulously collects vital personal information, including contact details and professional history, alongside requiring evidence of ongoing professional development or relevant work experience within the last three years. Moreover, it outlines the various reinstatement fees associated with each certification type, providing a clear financial roadmap for applicants. Payment options are accommodating, accepting several forms of credit card payments to ease the process. Applicants are reminded, however, of the importance of completing the form in its entirety and including the necessary fee to avoid delays. Positioned at 10700 W. Higgins Road, the American Medical Technologists (AMT) reinforces the importance of this form through its stringent submission policies, underscoring the organization's commitment to maintaining high standards within the allied health community.
| Question | Answer |
|---|---|
| Form Name | Amt Reinstatement Form |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names |
REINSTATEMENT FORM
Indicate the certification type for which you are seeking reinstatement.
Check all that apply: |
|
❏ Medical Technologist (MT) |
❏ Medical Laboratory Technician (MLT) |
❏ Registered Medical Assistant (RMA) |
❏ Registered Dental Assistant (RDA) |
❏ Registered Phlebotomy Technician (RPT) |
❏ Allied Health Instructor (AHI) |
❏ Certified Medical Administrative Specialist (CMAS) |
❏ Certified Medical Laboratory Assistant (CMLA) |
❏ Certified Laboratory Consultant (CLC) |
|
____________________________________________________________________________________________
First NameMiddle InitialLast Name
____________________________________________________________________________________________
Street AddressCity/StateZip Code
____________________________________________________________________________________________
____________________________________________________________________________________________
Maiden NameDate of BirthYear Initially Certified by AMT
____________________________________________________________________________________________
AMT ID# |
Social Security Number |
PRE 1/1/2006 CERTIFICATION
❏Within the last three years, I have completed A continuing education activity relevant to my certification and the required certificate of completion is attached. OR within the last three years, I have been working in my certification field and attached a letter from my employer documenting my employment.
Reinstatement Fees
Reinstatement fees are listed below
MT/MLT/CLC - $140
RMA/CMAS/RDA/CMLA/RPT - $100
|
AHI - $80 |
|
Total ___________ |
You can pay by check, money order or credit card |
|
||
❏ Visa |
❏ Master Card |
❏ Discover |
❏ American Express |
Name on Card: _______________________________________________ Amount: _________________________
Billing address of credit card holder: _______________________________________________________________
Account Number: _____________________________________________ Exp Date: ________________________
Signature: ___________________________________________________ Date: ____________________________
WE WILL NOT HOLD OR PROCESS ANY REINSTATEMENT FORM WITHOUT THE ENCLOSED REQUIRED FEE NOR WILL AMT PROCESS IF THE FORM IS NOT COMPLETELY FILLED OUT.
10700 W. Higgins Road Suite 150 - Rosemont, Illinois 60018 - Phone (847)