Section R9-16-502. Application for an Initial License

A.      An applicant for a speech-language pathologist assistant initial license shall submit to the Department an application packet that includes:

1.        An application in a format provided by the Department that contains:

a.         The applicant's name, home address, telephone num- ber, and e-mail address;

b.        The applicant’s Social Security number, as required under A.R.S. §§ 25-320 and 25-502;

c.         If applicable, the name of the applicant's employer and the employer's business address and telephone number;

d.        Whether the applicant has ever been convicted of a felony or of a misdemeanor involving moral turpi- tude in this state or another state;

e.         If the applicant has been convicted of a felony or a misdemeanor involving moral turpitude:

i.         The date of the conviction,

ii.        The state or jurisdiction of the conviction,

iii.      An explanation of the crime of which the appli- cant was convicted, and

iv.       The disposition of the case;

f.         Whether the applicant has had a license revoked or suspended by any state within the previous two years;

g.        Whether the applicant is currently ineligible for licensure in any state because of a prior license revo- cation or suspension;

h.        Whether the applicant agrees to allow the Depart- ment to submit supplemental requests for informa- tion under R9-16-505;

i.         An attestation that the information submitted is true and accurate; and

j.         The applicant’s signature and date of signature;

2.        If applicable, a list of all states and countries in which the applicant is or has been licensed as a speech-language pathologist assistant;

3.        If a license for an applicant has been revoked or sus- pended by any state within the previous two years, docu- mentation that includes:

a.         The date of the revocation or suspension,

b.        The state or jurisdiction of the revocation or suspen- sion, and

c.         An explanation of the revocation or suspension;

4.        If the applicant is currently ineligible for licensure in any state because of a prior license revocation or suspension, documentation that includes:

a.         The date of the ineligibility for licensure,

b.        The state or jurisdiction of the ineligibility for licen- sure, and

c.         An explanation of the ineligibility for licensure;

5.        A copy of the applicant’s:

a.         U.S. passport, current or expired;

b.        Birth certificate;

c.         Naturalization documents; or

d.        Documentation of legal resident alien status;

6.        An official transcript issued to the applicant from an accredited college or university, showing completion of at least 60 semester credit hours of general education and speech-language pathology technical course work, as required in A.R.S. § 36.1940.04(A);

7.        Documentation, signed by a licensed speech-language pathologist as required in A.R.S. § 36-1940.04 who pro- vided supervision to the applicant, confirming the appli- cant's completion of at least 100 hours of clinical interaction that did not include observation;

8.        A nonrefundable $100 application fee; and

9.        A $200 license fee.

B.       The Department shall review the application packet for an ini- tial license to practice as a speech-language pathologist assis- tant according to R9-16-505 and Table 5.1.

C.      If the Department does not issue an initial license to an appli- cant, the Department shall refund the license fee to the appli- cant.

Historical Note

New Section made by final rulemaking at 15 A.A.R. 2132, effective January 30, 2010 (Supp. 09-4). Section R9-16-502 repealed; new Section R9-16-502 renumbered

from R9-16-503 and amended by exempt rulemaking at 20 A.A.R. 1998, effective July 1, 2014 (Supp. 14-2).