Section Alc 304.04 - Additional Materials to be Submitted The additional materials to be submitted by an applicant for initial certification shall be:
(a) The test scores from the examination described in Alc 305 submitted to the board directly from the testing institution;(b) A photocopy of the applicant's: (2) Certificate of general educational development or equivalent credential issued by a state department of education;(3) Any other certificate showing that the applicant has earned the equivalent of a high school diploma; or(4) A transcript showing completion of a college degree program indicating education beyond a high school diploma;(c) The completed, signed, and notarized form required by the New Hampshire division of state police for the issuance and transmission to the board of the applicant's state and federal criminal conviction reports;(d) On a fingerprint card furnished by the board or live scan document, the set of fingerprints required by the New Hampshire division of state police for the issuance of the applicant's state and federal criminal conviction reports;(e) Unless the information is available only on a secure website, an official letter of verification sent directly to the board from every jurisdiction which has issued a license, certificate, or other authorization to practice recovery support or other work supporting treatment of individuals with substance use and integrated co-occurring disorders stating:(1) Whether the license certificate or other authorization is or was, during its period of validity, in good standing; and(2) Whether any disciplinary action was taken against the licensee, certificate, or other authorization to practice;(f) A written description of the circumstances if the applicant has checked the "yes" space for any of the "yes-no" questions on the "Initial Certification Application as a Recovery Support Worker" form;(g) Proof of compliance with any current orders described in Alc 302.01(b)(3) dated within 60 days of the date of submission of the "Initial Certification Application as a Recovery Support Worker" form;(h) The "Supervised Work Experience Report Form" from each of the private and public employer(s) for whom the applicant performed paid or volunteer work evidencing compliance with the work experience required by Alc 303.02 shall require: (1) Supervised work experience of at least 500 hours in duration;(2) The supervised work experience to be: a. Be paid or volunteer in nature;b. Involve direct services to clients;c. Be performed under the supervision of an individual approved by the board to supervise CRSW's; andd. Be performed in one or more of the following private or public settings: 1. A detoxification program;2. A substance use counseling program;3. A substance use treatment program; or4. In the substance use aspect of a healthcare, social service, or other direct service program; and(3) The supervised work experience to include:a. Monitoring by the supervisor of the performance of the person being supervised; andb. Record keeping and note taking by the supervisor which is sufficiently detailed to permit accurate later assessment of the work of the individual being supervised and accurate completion of the "Supervised Work Experience Report Form" as described in Alc 313.06;(i) Photocopies of all certificates of completion showing compliance with the training requirement in Alc 303.03, attaching additional sheets as necessary to provide the following information if it does not appear on the certificate: (1) The name of the applicant;(2) The title of the training;(3) The name of the training provider;(4) The date(s) and number of hours of the training;(5) If the training does not meet the requirements set forth in Alc 303.03(b), a description of the topic(s) covered by the training, in the form of a brochure or description issued by the training provider;(6) The signature of the training instructor or a representative of the provider or sponsoring or approving organization, together with the title of the person signing the certificate of completion; and(7) A list of the domains covered by the training;(j) The "Supervision Agreement" further described in Alc 313.09; and(k) The "Applicant Evaluation Form" described in Alc 313.10.N.H. Admin. Code § Alc 304.04
Derived From Volume XXXVI Number 45, Filed November 10, 2016, Proposed by #12001, Effective 10/13/2016, Expires 10/13/2026.Amended by Number 6, Filed February 9, 2023, Proposed by #13518, Effective 3/13/2023, Expires 3/13/2033 (see Revision Note at chapter heading for Alc 300).