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    Allied Requirement Form

    Uploaded by

    Kerry Henry
    This document is a proof of eligibility form for certification by American Allied Health. It provides instructions for applicants to select which form of documentation they will submit as proof of eligibility to sit for the certification exam - including proof of graduation from a vocational training program, one year of work experience in the field, or applying for certification by reciprocity. It outlines the requirements for each option and contact information to submit the completed form and supporting documentation.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Allied Requirement Form

    Uploaded by

    Kerry Henry
    47 views1 page
    This document is a proof of eligibility form for certification by American Allied Health. It provides instructions for applicants to select which form of documentation they will submit as proof of eligibility to sit for the certification exam - including proof of graduation from a vocational training program, one year of work experience in the field, or applying for certification by reciprocity. It outlines the requirements for each option and contact information to submit the completed form and supporting documentation.

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    Allied requirement form

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    This document is a proof of eligibility form for certification by American Allied Health. It provides instructions for applicants to select which form of documentation they will submit as proof of eligibility to sit for the certification exam - including proof of graduation from a vocational training program, one year of work experience in the field, or applying for certification by reciprocity. It outlines the requirements for each option and contact information to submit the completed form and supporting documentation.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    47 views1 page

    Allied Requirement Form

    Uploaded by

    Kerry Henry
    This document is a proof of eligibility form for certification by American Allied Health. It provides instructions for applicants to select which form of documentation they will submit as proof of eligibility to sit for the certification exam - including proof of graduation from a vocational training program, one year of work experience in the field, or applying for certification by reciprocity. It outlines the requirements for each option and contact information to submit the completed form and supporting documentation.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    American Allied Health, P.O.

    Box 1487, Lowell, AR 72745, (479)-553-7614

    Proof  of  Eligibility  Form  


     
    Member  Name:  ______________________________  
     
    Certification  Number:  ________________________  
     
    Directions:  (1)  Select  which  form  of  documentation  you  wish  to  submit  as  proof  of  eligibility  
    to  sit  for  the  American  Allied  Health  certification  exam,  (2)  comply  with  the  directions  given  
    in  either  option  a,  b,  or  c,  and  (3)  mail  or  fax  in  this  form  to  American  Allied  Health.    
     
    Check  ONE  of  the  boxes  below:  
    [    ]    (a)  Proof  of  graduation  from  vocational  training  program,  or  military  training.    
    [    ]    (b)  Proof  of  one  year  of  work  experience  in  the  field.    
    [    ]    (c)  Apply  for  certification  by  reciprocity.      
     
    Option  (a):  Mail  or  fax  this  form  along  with  a  copy  of  your  proof  of  training  (e.g.,  certificate  
    of  training,  diploma)  to  the  contact  information  at  the  bottom  of  this  page.    
     
    Option  (b):  Have  your  employer  or  supervisor  fill  out  the  following  information:  
     
    “I  (supervisor’s  name)  ______________________  certify  that  (AAH  member’s  name)  
    _______________________  has  been  employed  as  an  allied  heath  professional  with  at  
    least  one  year  of  work  experience  in  the  field.”  
    Supervisor’s  Name:  ___________________________  
    Supervisor’s  Signature:  ________________________  
    Supervisor’s  Phone:  ___________________________  
     
    Option  (c):  If  you  have  previously  been  certified  with  another  certification  organization  
    within  the  last  five  years,  submit  the  following  information:  
     
    Previous  Certification  Organization:  ____________________________  
    Certification  Number:  ________________________________________  
    Certification  Expiration:  ______________________________________    

    American Allied Health


    P.O. Box 1487
    Lowell, AR 72745
    Ph: (479) 553-7614
    Fax: (479) 553-7285

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