Ariz. Admin. Code § R9-13-114 - Vision Screening Trainer Certificate of Completion
A. An individual
who meets the eligibility requirements, as specified in
R9-13-113(A), may
apply for a vision screening trainer certificate of completion by submitting a
request to the Department, in a Department-provided format, that includes:
1. The individual's name, address, e-mail
address, and telephone number;
2.
If the individual is a licensed optometrist or ophthalmologist, as specified in
R9-13-113(A)(1),
the:
a. Optometrist or ophthalmologist
license number, and
b. Date of
expiration;
3. If the
individual is a registered nurse according to A.R.S. Title 32, Chapter 15, as
specified in
R9-13-113(A)(2),
the:
a. Registered nurse license number,
and
b. Date of
expiration;
4. If the
individual has completed 30-semester credits, as specified in
R9-13-113(A)(3),
all applicable academic transcripts demonstrating that the qualifying
educational requirements have been met;
5. If the individual is a vision screener who
has maintained a vision screening certificate of completion for the previous
five years, as specified in
R9-13-113(A)(4),
the:
a. Names of the school districts where
the vision screener provided vision screenings, and
b. Vision screener's certification of
completion date of expiration;
6. Whether the individual completed the
vision screenings, as specified in
R9-13-113(A)(4) ;
and
7. An attestation that:
a. The applicant will comply with the
requirements in
R9-13-113, and
b. The information provided in the request
for the vision screening trainer certificate of completion is true and
accurate; and
c. The individual's
signature and date of signature.
B. Within 30 calendar days after the date the
Department receives an individual's request for a vision screening trainer
certificate of completion, the Department shall send a notification to the
individual regarding the information on how the individual may register to take
a vision screening classroom instruction and written examination.
Notes
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