876 IAC 3-3-15 Application for examination

Sec. 15. (a) An application for examination shall be filed on a form prescribed by the board. (b) The board shall require applicants to provide documentation in support of education, experience, and other relevant data. (c) The form prescribed by the board may require an applicant to provide information and documentation including, but not limited to, the following: (1) A designation establishing the basis and type of certification sought by the applicant. (2) General relevant contact information for the applicant. (3) Educational transcripts, or other acceptable documentation, establishing that the applicant has met the educational requirements set forth in this rule. (4) A statement of all prelicensing education accrued, including the course title, sponsor, number of credit hours, and the date completed. (5) A listing of additional professional licenses held in Indiana or another state or states, including the license type, the state or states where the license is held, the license number, the issuance date, and the status of the license. (6) Except for minor traffic violations and convictions expunged, a statement describing criminal convictions incurred by the applicant prior to making application.