N.H. Admin. Code § Ch 302.05
An applicant for initial licensure shall sign and date the following statement preprinted on the application form:
"I herewith apply for a license to practice chiropractic in accordance with RSA 316-A and the rules of the New Hampshire Board of Chiropractic Examiners. I am the applicant identified in the application and the submitted photograph is a true likeness of me. I will notify the board in writing within 30 days of any change in the information provided in the application, even after the application has been granted and a license issued. I consent to the board's use for all purposes of the mailing and electronic addresses provided to the board in the application or thereafter. The information provided on the application form and the documentation provided to support the application are, to the best of my knowledge and belief, true, accurate, complete and unaltered. I acknowledge that, pursuant to RSA 641:3, I, the knowing making of a false statement on the application form is punishable as a misdemeanor, and, should I knowingly provide the board with any false, inaccurate, incomplete or altered information or documentation, the board has the authority to deny the application or, after a hearing, to take disciplinary action against any license issued to me."
N.H. Admin. Code § Ch 302.05
#8187, eff 10-8-04; ss by #10433, eff 10-5-13