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FILL OUT OUR APPLICATION BELOW

(TAKING CERTIFICATION EXAM OR WAIVER CERTIFICATION)

Name*

Street/P.O. Box Address*

City, State, Zip*

Telephone*

Email Address*

Name of School Attended*

Year Graduated*

Employer*

Number of Years Working*

Supervisor/Manager's Name*

Examination to be taken (pls. check)*

WHERE DO YOU WANT TO TAKE THE EXAM?*

TYPE OF APPLICATION:*

OLD (FOR RENEWAL) CERTIFICATION NUMBER*

Message

Thank you for contacting us.
We will get back to you as soon as possible

PBT, CNA, PCT, OR , EKG, Dialysis Tech, Pharmacy Tech & Medical Asst.

National Examination NOW ON-LINE! (take it anytime)

* Submit your on-line form

* Make your payment (visit our WEB STORE)

* Once all requirements were verified:

      1. We will send you confirmation e-mail for the test link,

          username & password

      2. You will have a 2 hour window to complete and submit

          the test.

Visit our Web Store to make an on-line payment for your ASMT Certification Exam and or your Waiver Fee

Note:

2 recent passport pictures, copy of school diploma/certification or waiver letter, must be submitted & received, before you can take the examination


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