R4-21-202. Licensure by Endorsement

A. An individual is eligible to apply for licensure by endorsement if the individual: 1. Graduated from an accredited optometry program; 2. Is licensed to practice the profession of optometry in another state that has licensing requirements that the Board determines meet or exceed Arizona's requirements; 3. Has engaged in the practice of the profession of optometry continuously in the other state or military for at least four of the five years before the date of application; and 4. Has not had a license to practice the profession of optometry suspended or revoked by any licensing jurisdiction for a cause that is a ground for suspension or revocation of a license in Arizona. B. To apply for licensure by endorsement, an individual who is eligible under subsection (A) shall submit the application form described in R4-21-201(B). C. In addition to complying with subsection (B), an applicant for licensure by endorsement shall submit or have submitted on the applicant's behalf: 1. The materials required under R4-21-201(C)(1) through (C)(4) and (C)(6) through (C)(10); 2. A state board certification and license verification form, which is submitted directly to the Board from the state that issued the license on which the applicant's endorsement application is based, indicating: a. Name and title of the individual completing the verification form; b. Applicant’s optometry license number in the state; c. Date on which the applicant was issued an optometry license by the state; d. A statement of whether the applicant: i. Has been licensed in the state for at least four of the last five years; ii. Is certified to use topical diagnostic, topical therapeutic, or oral pharmaceutical agents and if so, the date on which the certification was obtained; iii. Is currently in good standing in the state; iv. Is known to be licensed to practice the profession of optometry in another state and if so, the name of the other state; v. Has been subject to any disciplinary action and if so, the date, nature of, and reason for the disciplinary action; and vi. Is subject to any pending investigation or complaint and if so, the nature of the investigation or complaint; and e. The dated, notarized signature of the individual completing the verification form; and 3. A letter on official letterhead, in substantially the form provided by the Board, from a representative of the accredited optometry program at the educational institution from which the applicant graduated, providing details that demonstrate the applicant's education meets the standards at R4-21-207; and 4. If the applicant does not meet the requirements listed in R4-21-201 or R4-21-202(A)(2), a current certificate issued by the CELMO or its successor organization.