Ariz. Admin. Code § R4-24-201 - Application for a Physical Therapist License

A. An applicant for a physical therapist license shall submit to the Board an application packet that includes:

1. An application form provided by the Board that is signed, dated, and verified by the applicant and contains:

a. The applicant's name, business, residential, and e-mail addresses, business and residential telephone numbers, birth date, and Social Security number;

b. The name and address of each university or college attended by the applicant, the dates of attendance, and the date of graduation and degree received, if applicable;

c. The name and address of the university or college where the applicant completed an accredited educational program and dates of attendance;

d. A statement of whether the applicant has ever been licensed as a physical therapist in any other jurisdiction of the United States or foreign country;

e. Professional employment history for the past five years, including the name, address, and telephone number for each place of employment, job title, description of the work completed, and explanation of any breaks in employment, if applicable;

f. A statement of whether the applicant has ever been convicted of, pled guilty or no contest to, or entered into diversion in lieu of prosecution for any criminal offense in any jurisdiction of the United States or foreign country and if so, an explanation;

g. A statement of whether the applicant has ever had an application for a professional or occupational license, certificate, or registration, other than a driver's license, denied, rejected, suspended, or revoked by any jurisdiction of the United States or foreign country and if so, an explanation;

h. A statement of whether the applicant is currently or ever has been under investigation, suspension, or restriction by a professional licensing board in any jurisdiction of the United States or foreign country for any act that occurred in that jurisdiction that would be the subject of discipline under this Chapter and if so, an explanation;

i. A statement of whether the applicant has ever been the subject of disciplinary action by a professional association or post-secondary educational institution;

j. A statement of whether the applicant has committed any of the actions referenced in the definition of good moral character in R4-24-101;

k. A statement of whether the applicant has ever had a malpractice judgment, has a lawsuit currently pending for malpractice, or entered into a settlement from a malpractice suit and if so, an explanation;

l. A statement of whether the applicant is currently more than 30 days in arrears for payment required by a judgment and order for child support in Arizona or any other jurisdiction;

m. A statement of whether the applicant has any impairment to the applicant's cognitive, communicative, or physical ability to engage in the practice of physical therapy with skill and safety and if so, an explanation;

n. A statement of whether the applicant has, within the past 10 years, used alcohol, any illegal chemical substance, or prescription medications, that in any way has impaired or limited the applicant's ability to practice physical therapy with skill and safety and if so, an explanation;

o. A statement of whether the applicant has, within the past 10 years, been diagnosed as having or is being treated for bipolar disorder, schizophrenia, paranoia, or other psychotic disorder that in any way has impaired or limited the applicant's ability to practice physical therapy with skill and safety and if so, an explanation;

p. A statement of whether the applicant has ever violated A.R.S. § 32-2044(10); and

q. A statement by the applicant attesting to the truthfulness of the information provided by the applicant;

2. A passport photograph of the applicant no larger than 1 1/2 x 2 inches that was taken not more than six months before the date of the application;

3. Documentation, as described under A.R.S. § 41-1080, of the applicant's U.S. citizenship, alien status, legal residency, or lawful presence in the U.S.; and

4. The fee required in R4-24-107.

B. In addition to the requirements in subsection (A), an applicant shall arrange to have submitted directly to the Board:

1. An official transcript or letter showing that the applicant completed all requirements of an accredited educational program that includes the official seal of the university or college where the applicant completed the accredited educational program and signature of the registrar of the university or college,

2. Verification of passing a national examination in physical therapy as evidenced by an original notice of examination results, and

3. Verification of passing a jurisprudence examination as evidenced by an original notice of examination results.

C. In addition to the requirements in subsections (A) and (B), an applicant for a physical therapist license by endorsement shall submit to the Board:

1. The name of the licensing or certifying agency of any jurisdiction in which the applicant is currently or has been previously licensed;

2. A verification of each license, signed and dated by an official of the agency licensing or certifying the applicant, that includes the official seal of the licensing or certifying agency and all of the following:

a. The name of the applicant;

b. The license number and date of issuance;

c. The current status of the license;

d. The expiration date of the license;

e. A statement of whether the applicant was ever denied a license by the agency and if so, an explanation; and

f. A statement of whether any disciplinary action is pending or has ever been taken against the applicant and if so, an explanation.

D. The Board shall deny a license to an applicant who fails to meet the requirements of this Section or A.R.S. Title 32, Chapter 19. An applicant denied a license may request a hearing under A.R.S. Title 41, Chapter 6, Article 10.

Notes

Ariz. Admin. Code § R4-24-201

Adopted effective June 3, 1982 (Supp. 82-3). Amended subsection (C) and added subsection (D) effective April 10, 1986 (Supp. 86-2). Amended effective May 7, 1990 (Supp. 90-2). Amended effective March 14, 1996 (Supp. 96-1). Section repealed; new Section adopted by final rulemaking at 5 A.A.R. 2988, effective August 12, 1999 (Supp. 99-3). Amended by final rulemaking at 6 A.A.R. 2399, effective June 9, 2000 (Supp. 00-2). Amended by final rulemaking at 12 A.A.R. 2401, effective August 5, 2006 (Supp. 06-2). Amended by final rulemaking at 14 A.A.R. 3418, effective October 4, 2008, (Supp. 08-3). Amended by final rulemaking at 25 A.A.R. 404, effective 4/6/2019.