Ariz. Admin. Code § 9-16-903

Current through Register Vol. 30, No. 45, November 8, 2024

Section R9-16-903 - Certification Initial Application

A. An applicant for a doula certification shall submit to the Department:

1. An application in a Department-provided format that contains:

a. The applicant's name, date of birth, home address, telephone number, and email address;

b. The applicant's Social Security number, as required under A.R.S. §§ 25-320 and 25-502;

c. Whether the applicant has completed high school or a high school equivalency program;

d. Whether the applicant is or has been certified as a doula in another state or country;

e. Whether the applicant has had a certification or license revoked or suspended by any state within the previous two years;

f. Whether the applicant is currently ineligible for certification or licensure in any state because of a revocation or suspension;

g. Whether any disciplinary action has been imposed by any state, territory or district in this country for an act related to the applicant's practice as a doula;

h. Whether the applicant agrees to allow the Department to submit supplemental requests for information under A.R.S. § 411075;

i. An attestation that the information submitted is true and accurate; and

j. The applicant's signature and date of signature;

2. If applicable, a list of all states and countries in which the applicant is or has been certified as a doula;

3. If a certificate or license for the applicant has been revoked or suspended by any state within the previous two years, documentation that includes:

a. The date of the revocation or suspension,

b. The state or jurisdiction of the revocation or suspension, and

c. An explanation of the revocation or suspension;

4. If the applicant is currently ineligible for any occupational certificate or license in any state because of a revocation or suspension, documentation that includes:

a. The date of the ineligibility for certification or license,

b. The state or jurisdiction of the ineligibility for certification or license, and

c. An explanation of the ineligibility for certification or license;

5. If the applicant has been disciplined by any state, territory, or district of this country for an act related to the applicant's practice as a doula, documentation that includes:

a. The date of the disciplinary action,

b. The state or jurisdiction of the disciplinary action,

c. An explanation of the disciplinary action, and

d. Any other applicable documents, including a legal order or settlement agreement;

6. Documentation of the applicant's citizenship or alien status that complies with A.R.S. § 41-1080;

7. As applicable, documentation that demonstrates compliance with:

a.R9-16-902(B)(3) and (4),

b.R9-16-902(C), or

c.R9-16-902(D); and

8. A fee specified in R9-16-909(A) and (B).

B. In lieu of the documentation required in R9-16-902(B)(3), and (4)(a) and (b), an applicant may submit documentation to the Department that includes:

1. The name of each state that issued the applicant a current certification, including:

a. The certification number of each current certification, and

b. The date each current certification was issued;

2. Documentation of the professional certificate or license issued to the applicant by each state in which the applicant holds a professional certificate or license;

3. A statement, signed and dated by the applicant, attesting that the applicant:

a. Has been certified or licensed in another state for at least one year, with a scope of practice consistent of a certified doula;

b. Has met minimum education requirements specified in this Article;

c. Has not voluntarily surrendered a certification or license in any other state or country while under investigation for unprofessional conduct; and

d. Does not have a complaint, allegation, or investigation pending before another regulatory entity in another state or country related to unprofessional conduct.

C. The Department shall review the application and required documentation for certification as a certified doula according to R9-16-907 and Table 9.1.

Ariz. Admin. Code § R9-16-903

New Section made by Exempt Rulemaking at 29 A.A.R. 803, effective 8/1/2023. Amended by final expedited rulemaking at 29 A.A.R. 3431, effective 10/4/2023.