Application For Initial Licensure or Certification

Ahp 601.01 Application For Initial Licensure or Certification. (a) The application form for initial licensure or certification shall be the “Application for Initial Licensure or Certification” form approved by the office of licensed allied health professionals board of directors on April 12, 2018. (b) The application form shall be provided by the board. (c) Applicants for full initial licensure and provisional licensure shall submit the following to the board: (1) A completed “Application for Initial Licensure or Certification” form, revised 4/12/18, for which the applicant shall: a. Complete the entire form using a keyboard or by printing the information legibly in ink; and b. Complete all sections of the entire form or designate them as not applicable; (2) A “2 x 2” photograph of the applicants face taken within the immediately preceding 6 months; and (3) A fee in accordance with Ahp 301.02. (d) The application form in (c)(1) above shall have the applicant’s notarized signature pursuant to Ahp 601.05. Source. #12725, eff 2-15-19