Section Mid 302.05 - Documentation Required to Support An Application for Initial CertificationApplicants for a first certificate to practice midwifery shall submit the following documentation at the time of application:
(a) A photocopy of a high school diploma or evidence of completion of high school equivalent;(b) A photocopy of the applicant's current certificate as a CPM; (c) Proof of having passed one college-level anatomy and physiology course or proof of receipt through examination of college-level credit in anatomy and physiology, in the form of: (1) An official transcript; or(2) An original signed letter issued by the registrar or records office of the institution awarding the college-level credit;(d) Official transcripts from, or photocopies of diplomas received from, all colleges and universities attended, if any; (e) Official transcripts from all midwifery schools and colleges attended, if applicable; (f) A photocopy of the front and back of: (1) The applicant's current cardiopulmonary resuscitation certificate, also known as basic life support for healthcare providers, issued by the American Heart Association; (2) The applicant's current certificate in adult cardiopulmonary resuscitation issued by the American Red Cross together with the applicant's current certificate in infant and child cardiopulmonary resuscitation issued by the American Red Cross; or (3) The applicant's current certificate in adult, child and infant cardiopulmonary resuscitation issued by Medic First Aid or by the American Safety and Health Institute;(g) A copy of the front and back of the applicant's current NRP provider card; (h) A copy of the certificate of completion of a course(s) in birth-related laceration repairs that are credentialed by one of the organizations listed in Mid 405.02(a)(2), or a copy of the transcript or module's educational objectives or syllabus for birth-related laceration repairs from the program that prepared the applicant for CPM certification;(i) The signed statement regarding the number of supervised birth-related laceration repairs from the preceptor as described in Mid 303.02(c)(3); (j) If applicable, a notarized affidavit disclosing criminal convictions; (k) The names, addresses, phone number, and written references from at least 4 people, including at least 2 from certified or licensed health care professionals familiar with the applicant's midwifery experience, and not more than one from a client, affirming the applicant's competence and high standards in providing midwifery care; and (l) For identification, a photocopy of the applicant' current driver's license, passport or other government-issued identification card bearing the applicant's picture.N.H. Admin. Code § Mid 302.05
#7421, eff 1-3-01, EXPIRED: 1-3-09
New. #9691, eff 4-8-10
Amended by Volume XXXVIII Number 50, Filed December 13, 2018, Proposed by #12660, Effective 11/5/2018, Expires 11/5/2028.Amended by Volume XL Number 2, Filed January 9, 2020, Proposed by #12939B, Effective 12/10/2019, Expires 12/10/2029.