VERIFICATION OF CLINICAL MEMBERSHIP IN AAMFT FORM (an electronic or paper copy of your membership can be sent in lieu of this form)

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.

NOTE: Applicant may submit photocopy of AAMFT clinical membership in lieu of this form.