N.H. Admin. Code § Gal 401.08

Current through Register No. 50, December 12, 2024

Section Gal 401.08 - Reinstatement Application Form

Unless another form is specified by these rules, a guardian ad litem who is seeking reinstatement shall provide the following on a reinstatement 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 applicant's mailing address of his or her GAL Business;

(4) The applicant's telephone number of his or her GAL Business; and

(5) The applicant's GAL business email address;

(b) Under the preprinted heading "Recent Employment History," the following information:

(1) The name of applicant's current employer, including self-employment; and

(2) The address and telephone number of applicant's current employer;

(c) Under the preprinted heading "Recent Education,"

(1) Whether the applicant has, within the last 3 years, 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; and

3. 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; and

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; and

4. 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 "Certification Status":

(1) The beginning and end dates of the applicant's most recent certification; and

(2) If the applicant is a guardian ad litem who was formerly certified by the board:

a. Whether the applicant's most recent certification, its expiration, or the request for reinstatement is subject to the terms of any settlement or agreement with the board;

b. Whether the applicant's most recent certification expired while under a period of suspension;

c. Whether the applicant's most recent certification was revoked by the board and, if so, whether the applicant has ever previously had his or her certification revoked and reinstated by the board;

d. Whether the application follows a resignation or surrender of the applicant's most recent certification and, if so, the date that the resignation or surrender was approved by the board;

e. Whether the application follows a previous unsuccessful attempt to renew the applicant's most recent certification and, if so, the date of that unsuccessful attempt; and

f. Whether the applicant is requesting new certification after his or her most recent certification was revoked by the board and, if so, whether the applicant has submitted a separate written request for a hearing on reinstatement;

(e) Under the preprinted heading "Professional Record and Ethics":

(1) Since submitting the most recent application whether or not any of the applicant's answers to the "Professional Records and Ethics" questions on the most recent application have changed;

(2) If the answer to (e)(1) above is yes, on a separate piece of paper, provide the following information:

a. The name, address, and telephone number of the organization, court, or entity taking such action;

b. The docket number of such action;

c. The type of action taken;

d. The date of action;

e. A description of the facts giving rise to the action;

f. A description of the reason for such action, including whether it was claimed the applicant engaged in misconduct in performance of his or her GAL duties or that applicant was not of good character; and

g. The procedural history of the matter, including whether the action was reversed or overturned on appeal;

(f) Under the heading "Other Information":

(1) Since the most recent application has applicant ever 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, land-lord/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 (f)(1) is yes, on a separate piece of paper, the following information:

a. The name and docket number of the case;

b. The name of the court in which the matter was pending;

c. The date the matter was initiated;

d. The description of the nature of the case; and

e. Whether the matter still pending;

(g) The applicant's name in print;

(h) 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

(i) The date of the signature described in (h) above.

N.H. Admin. Code § Gal 401.08

#8942, eff 9-15-07

Amended by Volume XXXVI Number 45, Filed November 10, 2016, Proposed by #12010, Effective 10/21/2016, Expires 11/1/2026.