When your driver's license has been suspended or revoked, you will need to complete an Amt Reinstatement Form in order to have your driving privileges reinstated. The first step is to determine whether you are eligible for reinstatement. There are a number of factors that will be taken into account, such as the reason for the suspension or revocation and how long it has been since your last violation. Once you have determined that you are eligible, you can begin the process of completing the form. Be sure to provide accurate and complete information, as any mistakes could delay or even prevent your reinstatement. In most cases, you will also need to provide proof of financial responsibility. If you have any questions about the process or what is required, be sure
| 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)