Drugs and alcohol don’t mix with our nation’s highways, rails and skies.

Substance Abuse Professional’sU.S. DOT Alcohol and Drug Testing RegulationQuali�cation and Re-Quali�cation Course

Want to become qualified as a Substance Abuse Professional (SAP)? Time to renew your SAP qualification?

ORDER FORM

Gain the required 12 hours of continuing education and examination through NAADAC’s Substance Abuse Professional’s U.S. DOT Alcohol and Drug Testing Regulation Qualification and Re-Qualification Course. For both new and re-qualifying applicants, this independent study course provides a reference manual that reflects the most current regulations and an examination that you may complete at your convenience within 90 days of purchasing the course. Upon receiving a passing score on the examination, applicants will be issued 12 CEs, an SAP Qualification Certificate to hang in their o�ce, 3 years of maintenance-free practicing, and a listing on our website to advertise their services. For more information on the SAP qualification and requirements, please visit www.naadac.org/sap-qualification.

In order to qualify as a SAP, you must have one of the following credentials:• Addiction counselor national level certification through the

NAADAC Certification Commission (NCC AP) or the International Certification & Reciprocity Consortium (IC&RC). Note: State level certification does NOT meet DOT requirements.

• Masters Addiction Counselor (MAC) certification through the National Board of Certified Counselors (NBCC)

• Licensed physician (Doctor of Medicine or Osteopathy)• Licensed or certified psychologist• Licensed or certified social worker• Licensed or certified employee assistance professional• Licensed or certified Marriage and Family Therapist (MFT)

Check enclosed, payable to “NAADAC” Charge my Visa MC AmEx

I am a member of NAADAC. Member #_________________

I am not a current member of NAADAC.

Total Due• New SAP: $307 member, $407 nonmember : $ __________• Re-qualifying SAP: $307 member, $407 nonmember : $ __________

( NOTE: You MUST submit a copy of your current license or certification with this order form. Please see above for a list of accepted credentials.)

FIRST NAME (please print clearly) MIDDLE INITIAL LAST NAME

NOTE: You MUST submit a copy of your current license or certification with this order form. If you do not hold an eligible credential, you will only be issued a Certificate of Completion for 12 CEs.

I am qualifying as a SAP for the first time. I am renewing my SAP qualification.

CARD NUMBER EXP. DATE

SIGNATURE

SHIPPING ADDRESS / CITY / STATE / ZIP

DIRECTORY LISTING ADDRESS / CITY / STATE / ZIP (Address shown on NAADAC’s website to advertise your services.)

EMAIL ADDRESS PHONE #

ORDER INFORMATION

PAYMENT INFORMATION

COMPLETE YOUR ORDERPlease mail this order form and copy of current credential to:NAADAC, 44 Canal Center Plaza, Ste 301, Alexandria, VA 22314Or fax this order form 703.741.7698. Questions? Please call us at: 800.548.0497

Updated in 2015