Application for 2025 Affiliate Fellow Status for the American College of Medical Toxicology (AFACMT)

If you are an active ACMT member in good standing for at least 4 consecutive years, you are eligible to apply for Affiliate Fellowship status in the American College of Medical Toxicology. Join this admirable group of medical toxicologists by filling out the following application.


In order to be considered for affiliate fellowship status, applicants must meet the requirements in at least two of the following categories: clinical practice, research, formal teaching, public service, service to the college. However, we encourage you to make the application as complete as possible.


Two letters of recommendation are also required. If you have previously applied and not been accepted, we encourage you to reapply if your status has changed. Members from the membership committee and ACMT staff would be happy to help with any questions or concerns regarding the application process.


It is expected that if you are accepted as an Affiliate Fellow of ACMT, that you will attend the Annual Scientific Meeting in the Spring to receive your certificate.


Eligibility: Applicants must be a current active Affiliate ACMT member and have been in good standing for at least 4 years.


Application Process: Eligible ACMT members will be periodically reminded by mailings and announcements of availability of application materials for Affiliate Fellow status. The application process will be initiated by the member and does not require nomination.


The application steps and corresponding guidelines are as follows:

1. Affiliate Fellow applications may be completed at any time by the applicant on this page. Complete applications must be received by October 1st to be considered that calendar year.

2. Applications will be reviewed by ACMT staff for completeness and verification that they will have fulfilled the four-year membership requirement by the time of the Annual Scientific Meeting at which they will be accepted. The ACMT office will notify applicant one time of the letters of recommendations needed by email.

3. Letters of recommendation must come from active Full, International, or Affiliate members of the College and contain a valid signature, either by hand or digitally. Signed letters can be emailed to membership@acmt.net.

4. Copies of applications will be forwarded to ACMT Membership Committee members for review.

5. A quorum (majority of all Committee members) must meet to vote on the applications. A two-thirds vote of the Committee members present will be required for recommendation.

6. All applicants will be notified of their status via email.

7. Applicants not recommended for approval by the Membership Committee shall be able to submit a written appeal for review and reconsideration of the application by the ACMT Board. If an applicant is recommended by the Committee, but not approved by ACMT membership, no further appeal will be heard, but the applicant may reapply for Affiliate Fellow status the following year.

8. New Affiliate Fellows will be announced at the ACMT Annual Scientific Meeting. It is expected that you will attend the meeting where your Fellowship status is announced.


Directions: Complete at least one of the criteria in as many categories as you can below. Applicants are encouraged to provide evidence of meeting more than one criterion in each category if possible.


Application Deadline: October 1, 2024

Criterion 1: Practice

Academic or Private Setting

Are you practicing toxicology in a medical setting, either academic or private?

Industrial / Government Setting

Are you practicing in an industrial or government setting?

Utilize Practice as one of my criteria:*

Please note that attending time in the emergency department does NOT constitute time considered as medical toxicology.

Please list all medical toxicology practice locations, including dates and percentage of professional activities that this entailed. The clinical practice of medical toxicology as a minimum of 50% of professional activities for a minimum of 4 years is required to meet this criterion.

(If different from practice location) Please list all medical toxicology consultation locations, including dates and the percentage of professional activities that these consultations entailed. The practice of medical toxicology consultations as a minimum of 50% of professional activities for a minimum of 4 years is required to meet this criterion.

With regards to industrial or governmental toxicology service, please list job title/position, the location of the practice, the dates and percentage of professional activities that these positions entailed. Service to industry or government in the field of toxicology of pharmaceuticals as a minimum of 50% of professional activities for a minimum of 4 years is required to meet this criterion.

Criterion 2: Formal Teaching

Have you held any of the following positions?

Please list all medical toxicology teaching sites (hospital, university, etc.), associated academic appointment (if applicable) and dates of formal teaching. Formal teaching of medical toxicology to health care professionals or trainees for a minimum of 4 years is required to meet this criterion.

Please list a minimum of four (4) textbook chapters and/or medical journal publications, including case reports in the field of medical toxicology (in reference format in which you are author or co-author)

Please list all faculty appointments in medical toxicology teaching programs and applicable dates. A faculty appointment in a medical toxicology teaching program for a minimum of 4 years is required to meet this criterion.

Utilize Formal Teaching as one of my criteria:*

Publications used to satisfy formal teaching should NOT be used to satisfy research.

Criterion 3: Research

Have you published any of the following?

(not counting abstracts, case reports, letter to the editor)

Please cite at least four (4) reports of original research in medical toxicology of an investigatory nature that have been peer reviewed in which you are a contributing author, not including case reports, abstracts or letters to the editor.

Please cite at least two (2) reports of original research in medical toxicology of an investigatory nature that have been peer reviewed in which you are the lead author, not including case reports, abstracts or letters to the editor.

Utilize Research as one of my criteria:*

Publications used to satisfy research should NOT be used to satisfy formal teaching.

Criterion 4: Public Service

Have you ever been a Poison Center Director?
Have you ever been an Assistant Poison Center Director?

Please list the regional poison center, your role (director, medical director, assistant director, assistant medical director) and the dates that you filled that role. Service as a Director/Medical Director or Assistant Director/Assistant Medical Director of a poison center for a minimum of 4 years is required to meet this criterion.

Please list your affiliation as a member of a governmental or public committee addressing medical toxicology issues, your position and dates of involvement. The minimum duration of this affiliation required to meet this criterion is 4 years.

Please list your affiliation as a member of a governmental or public committee addressing medical toxicology issues, your position and dates of involvement. The minimum duration of this affiliation required to meet this criterion is 4 years.

Please list your affiliation in a public service organization related to medical toxicology, your role (director, chairman or other leadership) and dates of involvement. The minimum duration of service in a leadership role (Chairman, Director, or other) required to meet this criterion is 4 years.

Utilize Public Service as one of my criteria:*

Criterion 5: Service to the College

Member of an ACMT committee?
Organized an ACMT meeting or pre-meeting?
Served on an ACMT meeting organization committee?
Presented at an ACMT meeting?

(Not including poster presentations)

Written an ACMT Position Statement or White Paper?

Please list your ACMT committee affiliation(s), your role on the committee(s) and your dates of service. The minimum duration of ACMT committee membership required to meet this criterion is 4 years.

Please list any board affiliation you may have (Board of Directors of ACMT), your position on the board and your dates of service. The minimum duration of ACMT Board of Director membership required to meet this criterion is 3 years.

Utilize Service to the College as one of my criteria:*

Identify two current full, international, or affiliate members of ACMT (email address and telephone) from whom you will procure recommendations. Letters should address specific categories pertinent to your application. Letters may be emailed to membership@acmt.net. With a digital signature, they will be considered final. If no digital signature is available, a signed copy may be faxed to 844-226-8333. List who will be submitting your letters of recommendation in the box below. Please include their name and email address:

Please attach your CV here or email it after submission to membership@acmt.net with the subject "FACMT Application" and your name.

Drag and drop files here or

This bio will be displayed on a powerpoint slide. Please provide bulletpoints with the information below:

  • Year you joined ACMT
  • Name of Schools Attended (Residency, Fellowship, etc.)
  • Clinical Title, Name, Location
  • Academic Title, Name, Location
  • Additional Titles, Role(s), Location
  • Any other projects, ACMT-related tasks you'd like to mention

By checking the following box, I certify that all information contained within this application is accurate to the best of my knowledge, and I have satisfied the eligibility criteria. You must check this to certify your completed application.

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