If you are a human and are seeing this field, please leave it blank. VERIFICATION OF CLINICAL MEMBERSHIP IN AAMFT FORM (an electronic or paper copy of your membership can be sent in lieu of this form) Applicant's Name I have applied to the National Credentialing Academy and am required to provide verification of my clinical membership granted by your association. Please complete the information requested below and mail the form directly to NCA at the address below. My application cannot be processed until this form is received. Date 1. Is the applicant a clinical member of AAMFT? YESNO Date of Membership Exp. Date 2. Is the applicant currently in good standing? YESNO If NO, please comment in box below. FORM WAS COMPLETED BY: NOTE: Applicant may submit photocopy of AAMFT clinical membership in lieu of this form.