Online Application

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AMERICAN ASSOCIATION OF DRUGLESS PRACTITIONERS
CERTIFICATION & ACCREDITATION BOARD
COMMISSION ON CERTIFICATION

2200 Market Street, Suite 803
Galveston, TX 77550-1532

(888) 764-AADP | Email: join@aadp.net

If you wish to submit your application online, please fill out the form below. Please note that you will need to have a copy of your driver's license or passport and your degree/certificates to upload to this form.

EVALUATION APPLICATION

Name:*

Current Home Address:*
Business Address (put "Same" if not different)*

Home Phone*

Office Phone*

Referral Phone*

E-mail:*
Website

Date of Birth*

SSN (Last 4 digits Only)*

Sex*

State/Country practicing or plan to practice*


HOLISTIC EDUCATION/TRAINING

School*

Certificate or Degree*

Certificate or Degree Date*

Certificate/Degree

COLLEGE EDUCATION

Name

Degree(s)

Graduation Date

College 2 Name

Degree(s) 2

Graduation Date 2

Certification & Application Fee of $285.00 (U.S. Funds)

Application processing fee of $25.00 (non-refundable)
Certification fee of $260.00 (refundable if not certified)

Upload a copy of Drivers License or Passport*
Upload a copy of Holistic Education Certificate (Can Upload Multiple Files)*
Upload a copy of College Degree (Can Upload Multiple Files)

I understand that laws may vary from one state to another. If certified, I will become aware of, and abide by, any and all state regulations.

I certify that all statements and information provided herein are true and accurate.

Accept Here*