AACT Fellowship Application

2025 Fellow of the AACT Application

This is the application for Designation as a Fellow of the American Academy of Clinical Toxicology. Deadline to submit application is June 1.

Step 1 of 3

Application Submission Date*
MM slash DD slash YYYY
Applicant's Name*
First Last Credentials
Nomination Letter
Applicants must receive a nomination letter from a current Fellow of AACT in order for the application to be complete. The nominator will automatically be contacted with instructions and the deadline to submit your nomination letter.
Nomination Letter:*
Enter the name and email address of the Fellow of AACT who is submitting the nomination letter on your behalf.
First Last
Email Address for the AACT Fellow who is submitting a nomination letter on your behalf*
Recommendation Letters
Applicants must receive two letters of recommendation from current Fellows of AACT in order for the application to be complete. The individuals you list below will automatically be contacted with instructions and the deadline to submit your recommendation letters.
Letter of Recommendation #1:*
Name and email address of the Fellow of AACT who is submitting a recommendation letter on your behalf.
First Last
LOR 1: Email Address for the AACT Fellow who submitting a recommendation letter on your behalf*
Letter of Recommendation #2:*
Name and email address of the Fellow of AACT who is submitting a recommendation letter on your behalf.
First Last
LOR 2: Email Address for the AACT Fellow who submitting a recommendation letter on your behalf*
Contact Information for Applicant
Preferred Address for Contact*
Business Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email Address*
Phone*
First Year of membership in AACT*
List all years of AACT membership (clearly indicating any gaps)

Service to AACT Core Functions
AACT Executive Committee or Officer*
Dates of Term*
AACT Board of Trustees Member*
Dates of Term*
AACT Committee Chair*
Includes ABAT President
List name(s) of Committee and Dates of Service*
AACT Committee Member*
Includes ABAT Board Member
List name(s) of Committee and Dates of Service*
List names of Committees and dates of service along with your contribution to each committee
AACT Section Chair*
Includes ABAT Committee Chair
Name of Section/ABAT Committee and dates of service*
AACT Section Member with Active Participation*
Includes ABAT Committee Member
Dates of Section Membership/ABAT Committee Membership and Contribution(s) to each*
NACCT Participation
AACT Pre-Meeting Symposium Chair or Organizer at NACCT*
Name and Date(s) of each symposium*
AACT Pre-Meeting Symposium Speaker*
Provide name and date(s) of each lecture or presentation*
NACCT Main Congress AACT Symposium (during NACCT) chair or organizer*
Provide name and date(s) of each symposium*
NACCT Main Congress AACT Symposium (during NACCT) Speaker*
Does not include platform sessions or lightening orals.
Provide Name and Date(s) of each lecture or presentation*
NACCT Abstract Committee Chair*
Provide Years of Service*
NACCT Abstract Reviewer*
Provide Years of Service*
Service to AACT or Affiliated Societies
AACT Webinar Presenter*
Includes ABAT Webinars
Date, Section or Webinar Title, and Presentation Title*
(e.g Pediatric Section Webinar, ABAT Journal Club)
Have you served as Editor or Senior Editor of the Clinical Toxicology Journal?*
Provide Years of Service*
Have you served on the Editorial Board for Clinical Toxicology?*
Provide Dates of Service*
Have you served as a reviewer for Clinical Toxicology*
Provide Years of Service and Average Number of Reviews per Year.*
Have you served as an AACT Tox Coach Program Mentor?*
Provide Years of Service*
Have you served as a member of the Advanced Hazmat Life Support Scientific Advisory Committee*
Provide Years of Service*
Have you served as an Advanced Hazmat Life Support Instructor*
Provide years of service and number of courses per year*
EAPCCT Committee Chair*
Provide Years of Service*
EAPCCT Committee member with active participation*
Dates of Committee Membership and Contribution to Committee*
EAPCCT Invited Speaker*
Provide name and date(s) of each lecture or presentation*
Other AACT Sponsored Activity Chair*
Dates of Service and Activities*
Describe any other AACT Sponsored Activities that you chaired.
Other AACT Sponsored Activity Participant*
Participation in AACT Sponsored Activity*
Describe any participation in AACT sponsored activity. Be specific and include date(s) of service.
AACT Representative for Sponsored Activity of Other Organization*
e.g. AACT Liaison
Provide years of service and describe activity*
AACT Questions of the Day Writer*
Minimum 5 questions per year to qualify
Provide number of questions/year*

2025 Fellow of the AACT Application

Step 1 of 3

Nomination Letter

Recommendation Letters

Contact Information for Applicant

Service to AACT Core Functions

NACCT Participation

Service to AACT or Affiliated Societies

Other Sustained Contributions to Toxicology

Teaching

Scholarship

Service

Curriculum Vitae

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