N.H. Admin. Code § Ahp 601.05
"I acknowledge that knowingly making a false statement on this application form is a misdemeanor under RSA 641:2, I. I certify that the information I have provided on all parts of the application form and in the documents that I have personally submitted to support my application is complete and accurate to the best of my knowledge and belief.
I also certify that I have read the statute and the rules of the Board and promise that, if I am licensed, I will abide by them. Based on the statute and rules governing the profession for which I am applying I have not committed any acts that would be grounds for disciplinary action in this or any other State.
If I am given a "Temporary License" to practice in the State of New Hampshire I attest to the fact that I am eligible for full licensure meeting all requirements set forth in the Board's Administrative rules including any active in the profession requirements."
N.H. Admin. Code § Ahp 601.05