Section Occ 403.10 - Supporting Materials The materials supporting the reinstatement application shall be as described below:
(a) A 2 X 2 photograph of the applicant's face taken within the immediately preceding 6 months;(b) On a separate sheet, a detailed report of the relevant circumstances concerning any answer in the affirmative from the application form specified in Ahp 601.03;(c) A written statement that the reinstatement applicant has not engaged in occupational therapy in New Hampshire on a volunteer or paid basis since the date that his or her license ceased to be valid in New Hampshire;(d) Either: (1) A criminal history records check form and fingerprint card, seeking both a New Hampshire and a federal records check, in accordance with the procedure specified by the NH department of safety at Saf-C 5700, Operation of the Central Repository: Criminal Records, with the required fee; a. If the federal criminal history records check shows the existence of a criminal record in another state, the applicant shall obtain a detailed criminal record check directly from that state and provide it to the board; or(2) An original, not a photocopy, of a criminal offender record report:a. Issued by each state where the applicant has resided or been licensed within the past 6 years, provided that such state(s) shall:1. Send the report to the board; or2. To the applicant for forwarding to the board;b. Covering the applicant under his or her name and any aliases; andc. Dated within the 6 months of the submission of the application.(e) A chronologically organized resume covering the 24 months immediately preceding the reinstatement application, reporting for each paid or volunteer occupational experience: (1) A description of the experience; (2) Whether the experience was as: a. A direct caregiver in occupational therapy;b. An occupational therapy educator;c. An occupational therapy administrator;d. An occupational therapy consultant;e. A member of an occupational therapy board or committee;f. A student enrolled full time in an advanced occupational therapy degree program; or(3) The time period of the experience described by its beginning and ending dates;(4) An estimate of the total number of hours of the experience;(5) The number of hours of the experience estimated on a per-week or per-month basis; and(6) The physical address of each separate experience;(f) An official letter of verification sent directly to the board from every state which has issued a license or other authorization to practice since the date that the reinstatement applicant's license ceased to be valid in New Hampshire, stating whether: (1) 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) Transcripts as required by Occ 302.04(d) if not previously submitted; and(h) Documentation of maintenance of continuing competence as described in Occ 406.N.H. Admin. Code § Occ 403.10
Derived from Volume XLII Number 32, Filed August 11, 2022, Proposed by #13417, Effective 7/26/2022, Expires 7/26/2032