Section R4-15-205. Application for Renewal of a License

An applicant for a renewal license shall submit:

1.        An application form that contains the licensee’s:

a.         Name;

b.        Massage therapy license number;

c.         Massage therapy license expiration date;

d.        Birthdate;

e.         Residence and practice addresses;

f.         Residence and practice telephone numbers;

g.        Mailing address;

h.        E-mail address;

i.         Alien status declaration if the licensee is not a citi- zen or national of the United States;

j.         Declaration of whether the licensee has been charged with or convicted of a felony or an offense involving moral turpitude or prostitution, solicita- tion, or a related offense or entered into a plea of no contest during the two-year period immediately pre- ceding the renewal application date and, if so, the licensee shall provide the following information:

i.         The charged felony or offense;

ii.        The date of conviction;

iii.      The court having jurisdiction over the felony or offense;

iv.       The probation officer’s name, address, and tele- phone number, if applicable;

v.        A copy of the notice of expungement, if appli- cable; and

vi.       A  copy  of  the   restoration  of  civil  rights,  if applicable;

k.        Declaration that the licensee has completed the con- tinuing education required by A.R.S. § 32-4225(E) during the two-year period immediately preceding the renewal application date or if audited, the docu- mentation required in R4-15-303(B); and

l.         Signature and date of submission; and

2.        The fee required in R4-15-102(A).

Historical Note

New Section made by final rulemaking at 12 A.A.R. 2759, effective September 9, 2006 (Supp. 06-3).

Amended by final rulemaking at 20 A.A.R. 2246, effec- tive August 5, 2014 (Supp. 14-3).