Arizona Administrative Code › Title 4 - PROFESSIONS AND OCCUPATIONS › Chapter 11 - STATE BOARD OF DENTAL EXAMINERS › Article 3 - EXAMINATIONS, LICENSING QUALIFICATIONS, APPLICATION AND RENEWAL, TIME-FRAMES › Section R4-11-301 - Application

Current through Register Vol. 30, No. 28, July 12, 2024
A. An applicant for
				licensure or certification shall provide the following information and
				documentation:
1. A sworn statement of the
				applicant's qualifications for the license or certificate on a form provided by
				the Board;
2. A photograph of the
				applicant that is no more than 6 months old;
3. An official, sealed transcript sent
				directly to the Board from either:
a. The
				applicant's dental, dental therapy, dental hygiene, or denturist school,
				or
b. A verified third-party
				transcript provider.
4.
				Except for a dental consultant license applicant, a dental, dental therapy, and
				dental hygiene license applicant shall provide proof of successfully completing
				a clinical examination by submitting:
a. If
				applying for dental licensure by examination, a copy of the certificate or
				scorecard sent to the Board directly from a clinical examination administered
				by a state or testing agency that meets the requirements of A.R.S. §
				32-1233(2), indicating that the applicant passed a state or regional testing
				agency examination that meets the requirements of A.R.S. § 32-1233(2)
				within the five years immediately before the date the application is filed with
				the Board;
b. If applying for
				dental therapy licensure by examination, a copy of the certificate or scorecard
				sent to the Board directly from a clinical examination administered by a state,
				United States territory, District of Columbia or testing agency that meets the
				requirements of A.R.S. § 32-1276.01(B)(3)(a). The certificate or scorecard
				must indicate that the applicant passed the examination within the five years
				immediately before the date the application is filed with the Board. The
				application must also include the applicant's Arizona dental hygiene license
				number;
c. If applying for
				dental hygiene licensure by examination, a copy of the certificate or scorecard
				sent to the Board directly from a clinical examination administered by a state,
				United States territory, District of Columbia or testing agency that meets the
				requirements of A.R.S. § 32-1285(2). The certificate or scorecard must
				indicate that the applicant passed the examination within the five years
				immediately before the date the application is filed with the Board;
5. Except for a dental consultant license
				applicant as provided in A.R.S. § 32-1234(A)(7), dental and dental hygiene
				license applicants must have an official scorecard sent directly from the
				National Board examination to the Board;
6. A copy showing the expiration date of the
				applicant's current cardiopulmonary resuscitation healthcare provider level
				certificate from the American Red Cross, the American Heart Association, or
				another certifying agency that follows the same procedures, standards, and
				techniques for cardiopulmonary resuscitation training and certification as the
				American Red Cross or American Heart Association;
7. A license or certification verification
				from any other jurisdiction in which an applicant is licensed or certified,
				sent directly from that jurisdiction to the Board. If the license verification
				cannot be sent directly to the Board from the other jurisdiction, the applicant
				must submit a written affidavit affirming that the license verification
				submitted was issued by the other jurisdiction;
8. If an applicant has been licensed or
				certified in another jurisdiction, a copy of the self-inquiry from the National
				Practitioner Data Bank that is no more than 30 calendar days old;
9. If the applicant is
				in the military or employed by the United States government, a letter sent to
				the Board directly from the applicant's commanding officer or supervisor
				verifying the applicant is licensed or certified by the military or United
				States government; and
10. The jurisprudence
				examination fee paid by a method authorized by law.