Section Gal 401.10 - Required Supporting Materials for ReinstatementIn addition to the completed reinstatement application form, a person shall also submit or cause to be submitted to the board:
(a) A fully executed state of New Hampshire criminal records release authorization form from the department of safety allowing for the disclosure of the applicant's current criminal record to the board;(b) A check made out to the New Hampshire department of safety in the amount specified by Saf-C 5703.10;(c) An original writing together with 3 copies from the central registry of founded abuse and neglect reports established under RSA 169-C:35 indicating that the applicant's name does not now appear in the central registry of founded abuse and neglect reports;(d) 4 copies of a photograph identification card or other document issued by a governmental agency, which card or certificate includes, at least: (1) A clear depiction of the applicant;(2) The applicant's name; and(3) The applicant's date of birth;(e) A written waiver of confidentiality, which includes the printed name and a dated signature of the applicant, stating that the application form, supporting documentation, and any other material received by the board from or about the applicant, may be disclosed to: (1) The supreme, superior, district, probate, and any other state court located in the state of New Hampshire, including the New Hampshire judicial branch family division;(2) The federal district court or any other court of the United States located in New Hampshire;(3) Any court in any jurisdiction other than the above, and any certifying board, which requests information on the applicant in connection with the appointment, registration, or certification of the person as a guardian ad litem;(4) CASA, if the person is a CASA volunteer; and(5) Any other person or entity not prohibited by law;(f) If the applicant's answer to Gal 401.08(e)(1) is yes and the information previously provided by the applicant on his or her most recent application form under the heading of "Professional Record and Ethics" in Gal 302.02(f) has changed in a manner that involves the issuance of an order, decision or other writing from a professional organization or supervising entity which sets forth the terms of a disbarment, revocation, suspension, reprimand, discipline, sanction, censure, disqualification, denial, or fine, suspension, or penalty: (1) 4 copies of the order, decision, or other writing if any from the entity imposing the fine, suspension, sanction, penalty, denial, disqualification, censure, discipline, reprimand, disbarment, or revocation, setting forth the factual findings and conclusions; and(2) If the disbarment, revocation, suspension, reprimand, discipline, sanction, censure, disqualification, denial, penalty, or fine has ended, or if it was subsequently reversed or overturned on appeal, 4 copies of the order, decision, or writing, if any, so relating to that matter;(g) In the case of a request for reinstatement which follows, is part of, or is covered by a settlement or agreement with the board, 4 copies of the settlement or agreement;(h) In the case of a request for reinstatement where the most recent certification ended as the result of a resignation or surrender of certification, 4 copies of the board's acceptance of the resignation or surrender pursuant to Gal 404.02;(i) If requested under Gal 401.03 or Gal 404.01, such additional information required by the board;(j) If the applicant is, at the time of his or her application, seeking approval of an activity not listed in Gal 403.03 for continuing education credit, a original signed request for approval together with 3 copies as described in Gal 403.06; and(k) An original signed written statement together with 3 copies as to why the applicant is seeking reinstatement.N.H. Admin. Code § Gal 401.10
#8942, eff 9-15-07; amd by #9523, eff 10-1-09
Amended by Volume XXXVI Number 45, Filed November 10, 2016, Proposed by #12010, Effective 10/21/2016, Expires 11/1/2026.