Section Gal 401.07 - Renewal Application Form Unless another form is specified by these rules, a guardian ad litem who is seeking a new period of certification shall provide the following on a renewal application form provided by the board:
(a) Under the preprinted heading "Personal Data": (1) The applicant's full name;(2) Any name by which the person has been known since submitting his or her most recent application form, including the dates that the name or names were used;(3) The mailing address of the applicant's guardian ad litem business;(4) The email address of the applicant's guardian ad litem business; and(5) The telephone number of the applicant's guardian ad litem business;(b) Under the preprinted heading "Recent Employment History," the following information: (1) The name of applicant's current employer, including self-employment;(2) The address and telephone number of applicant's current employer;(c) Under the preprinted heading "Recent Education," (1) Whether the applicant has, since the most recent application, completed the required 30 hours of continuing education;(2) Attaching a separate piece of paper if necessary, a log of courses containing the following information:a. The title of the activity;b. A brief description of the topics covered in the activity;c. Whether, in accordance with Gal 403.09, the person has retained in his or her possession such documentation which would serve to verify: 1. That the activity is of the nature described in Gal 403.02;2. The number of credits claimed; and3. The person's actual attendance at or participation in the activity within the applicable time period set forth in these rules;d. The date of the person's participation in the activity;e. The name of the person or entity sponsoring or otherwise arranging for the activity;f. The number of continuing education credits claimed for participation in each activity;g. If the activity was of one of the specific types of activity listed in Gal 403.03, identification of the category into which the activity falls;h. If the activity was not one of the specific types of activity listed in Gal 403.03: 1. A description of the activity;2. Whether or not the activity has been approved for continuing education credit under Gal 403.05 and Gal 403.06;3. If the activity has been approved for continuing education credit under Gal 403.05 and Gal 403.06, the date of approval; and4. If not previously approved for continuing education credit under Gal 403.05 and Gal 403.06, whether the applicant has submitted a request for approval described at Gal 403.06; (3) The total number of continuing education credits claimed in the period which pertains to the application;(4) The total number of continuing education credits required in connection with the application; and(5) The percentage of the total continuing education credits claimed that relate to service as an instructor under Gal 403.03(e), or (g), or any combination of those paragraphs; (d) Under the preprinted heading "Professional Record and Ethics": (1) Whether or not any of the applicant's answers to the "Professional Records and Ethics" questions on the most recent application have changed since filing the most recent application; and(2) If yes, on a separate piece of paper, the following information: c. Telephone number of organization;d. Court or entity taking such action;h. A description of the facts giving rise to the action;i. A description of the reason for such action, including whether it was claimed applicant engaged in misconduct in performance of his or her GAL duties or that applicant was not of good character; andj. The procedural history of the matter, including whether the action was reversed or overturned on appeal;(e) Under the heading "Other Information": (1) Whether the applicant has, since last filing an application for licensure, been a party to any family law or domestic relations proceeding, or any other non-criminal court case, proceeding or action of any type, in this or any other jurisdiction, including but not limited to any civil, equity, landlord/tenant, probate, bankruptcy, forfeiture, or other action, proceeding, or matter of any type whatsoever, other than traffic or parking offenses charged as a violation or cases in which the person served solely in the capacity of a guardian ad litem; and(2) If the answer to (e)(1) is yes, the following information on a separate piece of paper: a. Name and docket number of the case;b. Name of the court in which the matter was pending;c. Date the matter was initiated;d. Description of the nature of the case; ande. Whether the matter is still pending;(f) The applicant's name in print;(g) The applicant's signature certifying the following in a statement preprinted on the form: (1) The information provided by the applicant on or in connection with the application form is, to the best of the applicant's knowledge and belief, true, accurate, and complete and the documentation provided in support of the application is a true and complete version of the documentation submitted;(2) The applicant acknowledges that the information provided on the application form and the documentation provided to support the application is public information except to the extent exempted from public disclosure pursuant to RSA 91-A, court order, RSA 490-C or orders issued thereunder;(3) The applicant specifically acknowledges that any and all information submitted to the board may be divulged by the board to any potential appointing court as well as to such other entities or persons provided for by these rules or other law, including the New Hampshire judicial branch family division; and(4) The applicant acknowledges that, pursuant to RSA 641:3, knowingly making a false representation on the application form is punishable as a misdemeanor; and(h) The date of the signature described in (g) above.N.H. Admin. Code § Gal 401.07
Amended by Volume XXXVI Number 45, Filed November 10, 2016, Proposed by #12010, Effective 10/21/2016, Expires 11/1/2026.