R4-6-301. Application for a License by Examination

An applicant for a license by examination shall meet the requirements specified in A.R.S. § 32-3275 and submit a completed application packet that contains the following: 1. A statement by the applicant certifying that all information submitted in support of the application is true and correct; 2. The license application fee required under R4-6-215. In accordance with A.R.S. § 32-3272, the Board shall waive the application fee for an independent level license if the applicant paid the fee for an initial or renewal associate level license in this state and applies for the independent level license within 90 days after paying for the initial or renewal associate level license; 3. The applicant’s name, date of birth, social security number, and contact information; 4. Each name or alias previously or currently used by the applicant; 5. The name of each college or university the applicant attended and an official transcript for all education used to meet requirements; 6. Verification of current or previous licensure or certification ever held in the practice of behavioral health; 7. A list of every entity for which the applicant has worked during the last seven years; 8. If the relevant licensing examination was previously taken, an official copy of the score the applicant obtained on the examination; 9. A report of the results of a query of the National Practitioner Data Bank; 10. Documentation required under A.R.S. § 41-1080(A) showing that the applicant’s presence in the U.S. is authorized under federal law; 11. A completed and legible fingerprint card for a state and federal criminal history background check and payment as prescribed under R4-6-215 if the applicant has not previously submitted a full set of fingerprints to the Board, or verification that the applicant holds a current fingerprint card issued by the Arizona Department of Public Safety; and 12. Other documents or information requested by the Board to determine the applicant’s eligibility.