Change of Status Application

Change of Status Application

Members changing their status will pay 50% of the annual renewal fees for each applicable certification. They will continue to receive member benefits, including publications, and are eligible to serve on state society boards and state or national committees, but are ineligible to serve as delegates to the annual business meeting and may not hold national Board positions.
To apply for retired or disability status, you must be an active and certified member in good standing.
Member Name*

First NameLast Name
AMT ID number*
Email*
example@example.com
Phone Number

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Certifications (click all that apply)*

RMAMLS (MT)AHIRPTMLTCLCRDAMDTPCTDARCMLACMAS
N/A - Change of status being requested:*

RETIRED - To qualify, a member must not be currently working and must be 65 or older. In addition, documentation from an official source, such as the Social Security Board or written evidence from your employer, must be submitted for approval.DISABILITY—To qualify, a member must not be working at all due to a disability/ illness or injury classified as either permanent or long-term and lasting no less than a year. To maintain your status, documentation of circumstances from a physician is required either every three years or before the end of each three-year cycle. If applying based on long-term disability, the physician must indicate the anticipated timeframe until recovery.
Change of status being requested:

RETIRED - To qualify, a member must not be currently working and must be 65 or older.DISABILITY - To qualify, a member must not be working at all due to a disability/ illness or injury classified as either permanent or long-term with a duration of no less than a year.
Disability Status - Required Supporting Documentation

Documentation of circumstances from a physician, must be submitted for approval. If applying based on long-term disability, the physician must indicate the anticipated timeframe until recovery.

To maintain your status, documentation of circumstances from a physician is required either every three years or before the end of each three-year cycle.
Retired Status - Required Supporting Documentation

Documentation from an official source, such as the Social Security Board or written evidence from your former/last employer, must be submitted for approval.
Attach Supporting Documentation*

Browse Files
Please attach either PDF, jpg or word documents files as documentation. Cancelof
If unable to attach documentation electronically, please confirm that you will mail documentation within 30 days of this form being submitted.*

Submit via USPS mail
Optional comments
By clicking this box, I agree to electronically sign this document and attest to this information being correct.

If applying for Retired status, I hereby attest that I am not currently employed and do not intend to become re-employed in the foreseeable future.

Additionally, should my status change, I agree to contact AMT to bring my certification back to an Active and Certified Status and resume all requirements necessary to maintain certification. These requirements include payment of the full regular annual renewal fee and compliance with the Certification Continuation Program (CCP) if required.

I understand that my failure to abide by this attestation may result in disciplinary sanctions imposed by the AMT Judiciary Committee, which may include loss of certification status with AMT.
Agreement

Agree
Signature

Clear
By electronically signing this document I attest to this information being correct.
Please verify that you are human*
Should be Empty:

Change of Status Application

To apply for retired or disability status, you must be an active and certified member in good standing.

Disability Status - Required Supporting Documentation

Retired Status - Required Supporting Documentation