R4-20-107. Application for a Dispensing Optician’s License by Comity

An applicant for a dispensing optician’s license by comity shall submit an application packet to the Board that contains: 1. An application form provided by the Board, signed and dated by the applicant, that contains: a. The applicant’s name, Social Security number, address, and telephone number; b. The applicant’s dispensing optician license number and the state and date of licensure; c. A statement of whether the applicant has ever been convicted of a felony or of a misdemeanor involving moral turpitude in any state; d. A statement of whether the applicant has ever been denied a license or had a license suspended or revoked in any state; and e. A sworn statement by the applicant verifying the truthfulness of the information provided by the applicant; 2. A photocopy of the unexpired license and a written statement, signed by an officer of the Board that issued the license, that states the license is in good standing, and that the license is valid to dispense both eyeglasses and contact lenses; 3. A photograph of the applicant taken not more than six months before the date of application; and 4. The fee required in R4-20-112.