Each applicant for licensure by endorsement shall meet the requirements of Opt 301.01, and provide the following additional information:
(a) A chronological record of the applicant's professional practice from the date of first licensure in any jurisdiction, including the name and address of the practice, and a thorough description of the nature of the practice;(b) A statement as to whether the applicant has been the subject of disciplinary action of any kind by an optometric or other professional licensing authority, or has entered into a settlement agreement or consent decree with any such licensing authority, and, if so, the name of the licensing authority and a complete description of the misconduct alleged and the discipline or settlement involved;(c) A statement as to whether, at the time of application, the applicant is the subject of a misconduct investigation or disciplinary proceeding, or is negotiating a settlement of any misconduct allegations, with an optometric or other professional licensing authority in any jurisdiction, and, if so, the name of the licensing authority and a complete description of the misconduct alleged or the settlement involved; and(d) The name and address of any optometric specialty or certification board with which the applicant is now, or has previously been, credentialed, and the dates during which the applicant was credentialed.N.H. Admin. Code § Opt 302.02
(See Revision Note at part heading for Opt 100) #5839, eff 6-17-94, EXPIRED: 6-17-00
New. #7433, eff 1-25-01, EXPIRED: 1-25-09
New. #9558, eff 10-6-09
Amended by Volume XXXVII Number 41, Filed October 12, 2017, Proposed by #12383, Effective 9/16/2017, Expires 9/16/2027.