ABAT Credentialing Application

Instructions:

Please complete all applicable sections of this application before submission.
Upload all supporting documents under each pertinent section(s) of the ABAT Credentialing Application.
Completed and electronically signed applications will be submitted to the Chair of ABAT’s Credentialing Committee.
Due Dates: A completed version of this application (PDF or online submission) is due by July 1 for applicants completing a clinical toxicology training program under the direction of a DABAT or FAACT. A completed version of this application (PDF or online submission) is due by March 1 for all other interested applicants.
Fees: An application fee of $200 must be received within 10 days of receipt of your application. ABAT Exam Credentialing Application fee can be made online by clicking here. If credentialing is denied for any reason, the $200 application fee is nonrefundable. Upon application approval, you will be contacted by the Chair of ABAT’s Credentialing Committee for the $300 examination fee payment instructions.

Name
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Preferred Email
Enter Email Confirm Email
Preferred Mailing Address
Street Address City State / Province / Region ZIP / Postal Code Country
Phone
By signing below, I certify that the information provided in this application and any and all supporting material submitted is accurate and that all items have been completed as listed.
For Clinical Toxicology Post-Graduate Training Program Directors
By signing below, I certify that the information provided in this application is accurate and all items have been completed as listed.

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1. Education and Licensure