Application Forms

PURPOSE: This rule provides instructions for filing applications in the office of the State Board of Registration for the Healing Arts requesting licensure as a clinical perfusionist in the state of Missouri. (1) The applicant is required to make application upon a form prepared by the board. (2) No application will be considered unless fully and completely made out on the specified form and properly attested. (3) An applicant shall present with the application at least one (1) recent unmounted photograph, in a size not larger than three and one-half inches by five inches (3 1/2" × 5"). The photograph must have been taken within the two (2)-year period prior to application. (4) Applications shall be sent to the executive director of the State Board of Registration for the Healing Arts, P.O. Box 4, Jefferson City, MO 65102. (5) The board shall charge each person applying for licensure to practice as a clinical perfusionist, either by examination, certification or reciprocity, an appropriate fee established by the board. The fee shall be sent in the form of a bank draft or money order (Personal checks will not be accepted). (6) In all instances where the board, by rule or in the application form, has provided that it will accept copies in lieu of an original document, the applicant shall provide copies notarized by a notary public to verify that those copies are true and correct copies of the original document. The board will not recognize foreign notaries. The board shall accept the notarization of a United States consul. AUTHORITY: sections 324.136, 324.159 and 324.183, RSMo Supp. 1997.* This rule originally filed as 4 CSR 150-8.010. Original rule filed Dec. 2, 1998, effective June 30, 1999. Moved to 20 CSR 2150-8.010, effective Aug. 28, 2006. *Original authority: 324.136, RSMo 1997; 324.159, RSMo 1997; and 324.183, RSMo 1997.