Switch Eligibility Requirement | National Board of Medication Therapy Management

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NBMTM ID
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First Name*
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Last Name*
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Date of Birth*
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Gender*
- Male
- Female
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Mailing Address (line 1)*
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Mailing Address (line 2)
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City*
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Write here*
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Zip Code/Postal Code*
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Country*
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Phone number*
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Date*
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Select ONE of the following statements to meet board eligibility.*
- I have professional experience in medication therapy management as defined by the NBMTM.
- I have completed a training course in medication therapy management.
- I have a postgraduate degree in medication therapy management.
- I have completed a pharmacy residency program.
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For those who own their pharmacy/business, or those who do not have access to their supervisors, or are not comfortable with us reaching out to their supervisors, you have the option to sign an employment verification attestation form. Keep in mind, NBMTM will periodically audit these forms to ensure the integrity of our candidates.*
- I would like to self-certify my employment verification attestation form.
- I would like NBMTM to verify my employment directly with my employer.
Employer Name*
Job Title*
Full-Time Position?*
- Yes
- No
Answer "Yes" if you work at least 30 hours per week
Country*
Write here*
State/Province/Emirate*
City*
Supervisor's Name*
Supervisor's Email (must be company email)*
Supervisor's Phone Number*
Current Employer?*
- Yes
- No
Employment Begin Date*
Employment End Date
Would you like to add another employer?*
- Yes
- No
Employer Name*
Job Title*
Full-Time Position?*
- Yes
- No
Answer "Yes" if you work at least 30 hours per week
Country*
State/Province/Emirate*
Write here*
City*
Supervisor's Name*
Supervisor's Email (must be company email)*
Supervisor's Phone Number*
Current Employer?*
- Yes
- No
Employment Begin Date*
Employment End Date
Would you like to add another employer?*
- Yes
- No
Employer Name*
Job Title*
Full-Time Position?*
- Yes
- No
Answer "Yes" if you work at least 30 hours per week
Country*
State/Province/Emirate*
Write here*
City*
Supervisor's Name*
Supervisor's Email (must be company email)*
Supervisor's Phone Number*
Current Employer?*
- Yes
- No
Employment Begin Date*
Employment End Date
Training Course in Medication Therapy Management*
Write here*
Institution that granted your postgraduate degree in medication therapy management*
Write here*
Pharmacy Residency Program
- Medication Therapy Management (MTM)
- Ambulatory Care Pharmacy
Name of Institution of Pharmacy Practice Residency*

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1455 Pennsylvania Ave NW, Suite 400, Washington, DC 20004
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