Indiana Administrative Code › Title 828 - STATE BOARD OF DENTISTRY › Article 5 - INSTRUCTOR'S LICENSES › Rule 1 - General Requirements › Section 1-1 - Application

Current through July 10, 2024
Authority: IC 25-1-8-2; IC 25-13-1-5; IC 25-14-1-13; IC
				  25-14-1-27.5
Affected: IC 25-14-1-10
Sec. 1.
(a)
				Applicants for licensure as an instructor under IC 25-14-1-27.5 shall apply in
				the manner required by the board and shall submit the fee required by
				828 IAC 0.5-2-3.
(b) The applicant for an instructor's license
				shall provide the following:
(1) Where the
				name on any document differs from the applicant's name, a notarized or
				certified copy of a marriage certificate or legal proof of name
				change.
(2) Proof that the
				applicant has been approved under the credentialing process of an Indiana
				school of dentistry or an affiliated medical center of an Indiana school of
				dentistry as required under IC
				25-14-1-27.5. The proof shall
				include a notarized statement of approval submitted by an Indiana school of
				dentistry or an affiliated medical center of an Indiana school of dentistry and
				copies of all documentation reviewed by the school or affiliated medical center
				in determining its approval of the applicant.
(3) Documentation or a demonstration of
				clinical and academic competency, which shall include the following:
(A) If the applicant is a graduate of a
				school of dentistry outside the United States, its possessions, or Canada, the
				applicant must submit an original transcript of the applicant's dental
				education, including the degree conferred and the date the degree was
				conferred. If the original transcript is in a language other than English, the
				applicant must include a certified translation of the transcript. If an
				original transcript is not available, the applicant must submit the following:
(i) A notarized or certified copy of the
				original dental school transcript, which must include the degree conferred and
				the date the degree was conferred.
(ii) An affidavit fully and clearly stating
				the reasons that an original transcript is not available.
(B) If the applicant has taken the National
				Board Dental Examination provided by the Joint Commission on Dental
				Examinations or has taken the National Dental Examining Board of Canada Written
				Examination provided by the National Dental Examining Board of Canada, the
				applicant shall submit proof of having taken the examination and the results
				thereof.
(C) If the applicant has
				taken a clinical licensing examination in any other state, country, territory,
				or recognized jurisdiction, the applicant shall submit proof of having taken
				the examination and the results thereof.
(4) If the applicant has been convicted of a
				criminal offense, excluding minor traffic violations, a notarized statement
				detailing all criminal offenses, excluding minor traffic violations, for which
				the applicant has been convicted. This notarized statement must include the
				following:
(A) The offense of which the
				applicant was convicted.
(B) The
				court in which the applicant was convicted.
(C) The cause number under which the
				applicant was convicted.
(D) The
				penalty imposed by the court.
(5) An applicant who is now, or has been,
				licensed to practice any health profession in another state within the United
				States, or in any other country, territory, or recognized jurisdiction must
				submit verification of license status. This information must be sent by the
				state, country, territory, or other recognized jurisdiction that issued the
				license directly to the Indiana board.
(6) A self-query form completed by the
				National Practitioner Data Bank (NPDB) and the Healthcare Integrity and
				Protection Data Bank (HIPDB) data bank.
(7) Proof of completion of at least twenty
				(20) hours of continuing dental education in dentistry taken in the previous
				two (2) years. No more than two (2) hours of training in basic life support
				shall count toward this requirement. Practice management courses will not be
				accepted.
(8) Graduates of a school
				of dentistry outside of the United States in which the instruction was
				conducted in a language other than English shall submit proof of having passed
				the Test of English as a Foreign Language (TOEFL).
(9) Proof that the applicant has been
				licensed or has had the equivalent of a license to practice dentistry in the
				United States or in any country, territory, or other recognized jurisdiction
				for not less than five (5) years out of the nine (9) years immediately
				preceding the submission of the application.
(10) Proof that the applicant is currently
				certified in basic life support or advanced cardiac life
				support.