R4-15-205. Application for Renewal of a License

An applicant for a renewal license shall submit: 1. An application form that contains the licensee’s: a. Name; b. Massage therapy license number; c. Massage therapy license expiration date; d. Birthdate; e. Residence and practice addresses; f. Residence and practice telephone numbers; g. Mailing address; h. E-mail address; i. Alien status declaration if the licensee is not a citizen or national of the United States; j. Declaration of whether the licensee has been charged with or convicted of a felony or an offense involving moral turpitude or prostitution, solicitation, or a related offense or entered into a plea of no contest during the two-year period immediately preceding the renewal application date and, if so, the licensee shall provide the following information: i. The charged felony or offense; ii. The date of conviction; iii. The court having jurisdiction over the felony or offense; iv. The probation officer’s name, address, and telephone number, if applicable; v. A copy of the notice of expungement, if applicable; and vi. A copy of the restoration of civil rights, if applicable; k. Declaration that the licensee has completed the continuing education required by A.R.S. § 32-4225(E) during the two-year period immediately preceding the renewal application date or if audited, the documentation required in R4-15-303(B); and l. Signature and date of submission; and 2. The fee required in R4-15-102(A).