Amt Reinstatement Form PDF Details

The reinstatement form is submitted to American Medical Technologists (AMT), the non-profit certifying body at 10700 W. Higgins Road, Rosemont, IL 60018. Applicants who have not maintained their credentials through the Certification Continuation Program (CCP) must complete this application to reactivate their professional status and restore their certification status.

Who Qualifies for Certification Reinstatement

The reinstatement pathway is open to professionals who hold a lapsed credential in any of the following specialty areas:

Professionals whose certification lapsed within the past five years are typically eligible to reinstate without retaking the exam. Check the AMT eligibility requirements to confirm your certification status before applying. Those who lapsed longer may need to reapply for initial certification. Related certification documents are also available through medical certification forms and healthcare professional forms on FormsPal.

Steps to Complete the Reinstatement Process

  1. Confirm eligibility: Check AMT's CCP requirements to determine whether reinstatement or retesting applies to your certification status.
  2. Gather documentation: Collect proof of continuing education units (CEUs), records showing recent professional practice within the last three years, and a valid photo ID.
  3. Complete the application: Provide your full legal name, current contact information, certification number, specialty type, and professional history. Every field must be completed to avoid delays.
  4. Pay the reinstatement fee: AMT accepts Visa, MasterCard, and Express. Fee amounts vary by certification type.
  5. Submit your application: Send the signed form with payment to AMT at 10700 W. Higgins Road, Rosemont, IL 60018. Allow four to six weeks for review and approval.

Required Documentation

Before submitting your reinstatement application, prepare the following materials:

For additional related forms, review nursing reinstatement forms and phlebotomy license documentation available on FormsPal.

QuestionAnswer
Form NameAmt Reinstatement Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other names

Form Preview Example

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

____________________________________________________________________________________________

E-mail AddressHome Phone NumberWork Phone Number

____________________________________________________________________________________________

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) 823-5169 - Fax (847) 789-8582 - www.americanmedtech.org

How to Edit Amt Reinstatement Form Online for Free

Use the FormsPal editor to complete the reinstatement application online, then download and print the filled PDF for mailing. No software installation is required.

Steps to Fill Out the Form Online

  1. Click "Get Form Now" at the top of this page to open the form in the FormsPal editor.
  2. Enter your personal details: full legal name, mailing address, phone number, and email address.
  3. Type your certification number and select your credential type (MT, MLT, RMA, RPT, RDA, or other).
  4. Describe your professional history, including your employer name, job title, and employment dates showing recent practice in your specialty.
  5. Note the continuing education units you have completed, including provider names and completion dates.
  6. Review all entries for accuracy. Incomplete or inaccurate information can delay processing.
  7. Click "Download PDF" to save the completed form. Sign it and send it with your reinstatement fee to Medical Technologists, 10700 W. Higgins Road, Rosemont, IL 60018.

Frequently Asked Questions

What is the reinstatement fee?
The fee varies by certification type. Review the current fee schedule on the AMT website before submitting. Accepted payment methods include Visa, MasterCard, and Express.

How long does reinstatement take?
Applications are typically processed within four to six weeks after receiving a complete submission with payment. Incomplete applications may be returned without action.

Can I reinstate if my certification lapsed more than five years ago?
Certifications lapsed for five or more years generally require retaking the exam rather than using the reinstatement pathway. Check your eligibility directly with AMT before applying.

Where do I send the completed form?
Send the signed form with payment to Medical Technologists, 10700 W. Higgins Road, Rosemont, IL 60018.

For other professional healthcare documents, see non-FMLA medical certification forms and medical assisting resources on FormsPal.

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