N.H. Admin. Code § Phy 403.08

Current through Register No. 50, December 12, 2024

Section Phy 403.08 - Supporting Materials

The materials supporting the reinstatement application shall be:

(a) A recent passport size, 2" x 2", original head shot photograph;

(b) On a separate sheet, a detailed report of the relevant circumstances if any of the answers to the "yes-no" questions on the confidential part of the application form is in the affirmative;

(c) On a separate sheet, a detailed report of the relevant circumstances if any of the answers to the "yes-no" questions on the non-confidential part of the application form is in the affirmative;

(d) A completed work history form provided by the board;

(e) An original, not a photocopy, of a criminal offender record report:

(1) Issued by each state where the applicant has resided or been licensed within the past 6 years, providing that such state will:

a. Send the report to the board; or

b. To the applicant for forwarding to the board;

(2) Covering the applicant under his or her name and any aliases; and

(3) Dated within the 6 months preceding the application for licensure;

(f) Unless the information sought is available only on a website, an official letter of verification sent directly to the board from every state which has issued the applicant a license or other authorization to practice physical therapy since the lapse of the New Hampshire license, stating:

(1) Whether the license or other authorization is or was, during its period of validity, in good standing; and

(2) Whether any disciplinary action was taken against the license or other authorization to practice;

(g) A written statement that the reinstatement applicant has not engaged in physical therapy in New Hampshire on a volunteer or paid basis since the date that his or her license ceased to be valid;

(h) If applicable to the reinstatement applicant, proof in accordance with Phy 407 of having completed 24 hours of continuing education earned within the immediately preceding 2 years of submission of a completed application;

(i) If the reinstatement applicant re-took and passed the national examination in order to meet the requirement in Phy 403.06(b), the applicant's examination scores sent directly to the board by FSBPT;

(j) If the reinstatement applicant is eligible for conditional reinstatement, the completed supervision form described in Phy 404.05;

(k) The original, completed, jurisprudence examination provided to the applicant by the board; and

(l) Transcripts as described in Phy 303.01(c)(1) or (c)(3) if not previously submitted.

N.H. Admin. Code § Phy 403.08

#9431, eff 3-19-09; ss by #9653, eff 2-5-10; ss by #9869, eff 2-18-11; ss by #10203, eff 10-19-12; ss by #10402, eff 8-23-13

Amended by Volume XXXVII Number 6, Filed February 9, 2017, Proposed by #12088, Effective 1/20/2017, Expires 1/20/2027.