N.H. Admin. Code § Fam 603.02

Current through Register No. 50, December 12, 2024

Section Fam 603.02 - Application Form

(a) The application form, "Training Program Application for Certification", provided by the board shall:

(1) Be completed by typing or legibly printing in ink; and

(2) Have all sections completed or designated as not applicable.

(b) The individual applying for certification to operate a training program or the representative of the business entity applying for such certification shall provide the following on the "Training Program Application for Certification" form:

(1) Identification in the form of:

a. The name of the individual or business entity;

b. Other names the training program has used in the last 5 years, the dates any such name was used, and the reason for using a different name at that time;

c. The business address, business telephone number, and website, if applicable, of the individual or business entity;

d. The e-mail address for the individual or business entity, if there is one;

e. If it is a business entity that seeks certification, the name of the representative, the relationship of the representative making the application to the business entity seeking certification,

f. The business address, business telephone number, and website, if applicable, of such representative;

g. The name of each member of the training program's staff and indication of any of the following roles each has:

1. Director;

2. Trainer;

3. New Hampshire law specialist; or

4. Domestic violence specialist; and

h. For each person identified under g. above, the following applicable forms:

1. "Staff Information: Director" form, effective September 2018;

2. "Staff Information: Trainer" form, effective September 2018;

3. "Staff Information: NH Law Specialist" form, effective 2018; or

4. "Staff Information: Domestic Violence Specialist" form, effective 2018.

(2) The signature of the authorized signer below the following pre-printed statement:

"I certify that the information provided on this application form for renewal of certification and the materials provided to support the application are, to the best of the signer's knowledge and belief, true, accurate, complete and unaltered. The signer acknowledges that, pursuant to RSA 641:3, the knowing making of a false statement on the application form is punishable as a misdemeanor. The signer also acknowledges that the provision of false information in the application is a basis for disciplinary action by the Board."; and

(3) The date the signature is placed on the application form.

(c) The signature shall constitute:

(1) The certification that the information provided on the application form and the materials provided to support the application are, to the best of the signer's knowledge and belief, true, accurate, complete, and unaltered; and

(2) The acknowledgement that, pursuant to RSA 641:3, knowingly making a false statement on the application form is punishable as a misdemeanor.

N.H. Admin. Code § Fam 603.02

#9087, eff 2-16-08; ss by #9675, eff 4-2-10 (see Revision Note at chapter heading for Fam 600)

Amended by Volume XXXVIII Number 41, Filed October 11, 2018, Proposed by #12637, Effective 10/2/2018, Expires 10/2/2028.