Section Mid 402.05 - Application Form for Renewal of Certificate(a) An applicant for renewal of certification shall: (1) Complete the "Renewal of Midwifery Certificate" application form, effective 10/2016, furnished by the midwifery council electronically or legibly in ink;(2) Complete all sections of the renewal application form or designate them as not applicable;(3) Date the renewal application form; and(4) Sign the renewal application form in compliance with (b) below.(b) An applicant for renewal of certification shall:(1) Place his or her signature below the following statement preprinted on the renewal application form: "The information provided on the renewal application form and the documentation provided to support the renewal application are, to the best of my knowledge and belief, true, accurate, complete and unaltered. I acknowledge that, pursuant to RSA 641:3, the knowing making of a false statement on the renewal application form is punishable as a misdemeanor"; and
(2) Place the date next to his or her signature.N.H. Admin. Code § Mid 402.05
Amended by Volume XXXVI Number 49, Filed December 8, 2016, Proposed by #12040, Effective 11/10/2016, Expires 11/10/2026.