Ariz. Admin. Code § R4-21-202 - Licensure by Endorsement

A. An individual is eligible to apply for licensure by endorsement if the individual:

1. Graduated from an accredited optometry program;

2. Is licensed to practice the profession of optometry in another state that has licensing requirements that the Board determines meet or exceed Arizona's requirements;

3. Has engaged in the practice of the profession of optometry continuously in the other state or military for at least four of the five years before the date of application; and

4. Has not had a license to practice the profession of optometry suspended or revoked by any licensing jurisdiction for a cause that is a ground for suspension or revocation of a license in Arizona.

B. To apply for licensure by endorsement, an individual who is eligible under subsection (A) shall submit the application form described in R4-21-201(B).

C. In addition to complying with subsection (B), an applicant for licensure by endorsement shall submit or have submitted on the applicant's behalf:

1. The materials required under R4-21-201(C)(1) through (C)(4) and (C)(6) through (C)(10);

2. A state board certification and license verification form, which is submitted directly to the Board from the state that issued the license on which the applicant's endorsement application is based, indicating:

a. Name and title of the individual completing the verification form;

b. Applicant's optometry license number in the state;

c. Date on which the applicant was issued an optometry license by the state;

d. A statement of whether the applicant:

i. Has been licensed in the state for at least four of the last five years;

ii. Is certified to use topical diagnostic, topical therapeutic, or oral pharmaceutical agents and if so, the date on which the certification was obtained;

iii. Is currently in good standing in the state;

iv. Is known to be licensed to practice the profession of optometry in another state and if so, the name of the other state;

v. Has been subject to any disciplinary action and if so, the date, nature of, and reason for the disciplinary action; and

vi. Is subject to any pending investigation or complaint and if so, the nature of the investigation or complaint; and

e. The dated, notarized signature of the individual completing the verification form; and

3. A letter on official letterhead, in substantially the form provided by the Board, from a representative of the accredited optometry program at the educational institution from which the applicant graduated, providing details that demonstrate the applicant's education meets the standards at R4-21-207; and

4. If the applicant does not meet the requirements listed in R4-21-201 or R4-21-202(A)(2), a current certificate issued by the CELMO or its successor organization.

Notes

Ariz. Admin. Code § R4-21-202

Adopted effective February 7, 1986 (Supp. 86-1). Amended effective April 1, 1991 (Supp. 91-2). Section R4-21-202 repealed; new Section R4-21-202 renumbered from R4-21-204 and amended effective November 5, 1998 (Supp. 98-4). Amended by final rulemaking at 11 A.A.R. 1864, effective May 3, 2005 (Supp. 05-2). Former R4-21-202 renumbered to R4-21-203; new R4-21-202 made by final rulemaking at 14 A.A.R. 12, effective February 2, 2008 (Supp. 07-4). Amended by final rulemaking at 22 A.A.R. 328, effective 3/28/2016.