844 IAC 21-2-2 Application for license as an assistant behavior analyst

Sec. 2. (a) An applicant for licensure as an assistant behavior analyst shall provide the board with the information required in IC 25-8.5-3-2 and the following: (1) A completed application. (2) The fee required by section 4 of this rule. (3) Demographic information, including: (A) name; (B) date of birth; (C) Social Security number; (D) contact information; (E) citizenship information; (F) military history; (G) employment history; (H) gender; and (I) other states of licensure. (4) Information regarding fitness for practice, including disciplinary, criminal, and substance abuse history. (5) A statement from the appropriate agency in each state where the applicant has been licensed, certifying whether disciplinary proceedings: (A) have ever been initiated; or (B) are presently pending; against the applicant. (6) A signed contract with an LBA, and approved by the BACB, to provide supervision under 844 IAC 21-4-6. (b) The committee shall verify with: (1) the BACB, or its successor; or (2) another entity approved by the committee; that the applicant is currently certified in good standing as a BCaBA.