Eating Disorders Treatment Accountability Council

Your Name*
First Last
Your Email Address*
iaedp certification#:
We may verify that your certification is current and in good standing with iaedp.
iaedp expiration date:
MM slash DD slash YYYY
License #:*
We may verify that your license is current and in good standing with your licensing board.
License First Issued date:*
MM slash DD slash YYYY
License expiration date:*
MM slash DD slash YYYY
How long have you been working full time in the eating disorders field?*
What's your first references name?
First Last
How long has reference one been working full time in the Eating Disorders Field?
What is reference one's email?
Where does reference one work?
What is reference one's business address?
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
What's your second references name?
First Last
How long has reference two been working full time in the Eating Disorders Field?
What is reference two's email?
Where does reference two work?
What is reference two's business address?
Same address as reference one

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Verification Reference Request