A.
Before the expiration date of the temporary
speech-language pathologist license, a licensed temporary speech-language
pathologist shall submit to the Department:
1.
A renewal application in a format provided by the
Department that contains:
a.
The applicant's name, home address, e-mail address,
and telephone number;
b.
The applicant's license number and date of
expiration;
c.
The name of the applicant's employer, including the
employer's business address, and telephone number;
d.
The name, business address, telephone number, and
license number of the speech language pathologist providing supervision to the
applicant;
e.
Since the previous license application, whether the
applicant has been convicted of a felony or a misdemeanor involving moral
turpitude in this or another state;
f.
If the applicant was convicted of a felony or a
misdemeanor:
i. The date of the
conviction,
ii. The state or jurisdiction of
the conviction,
iii. An explanation of the crime
of which the applicant was convicted, and
iv. The disposition of the
case;
g.
An attestation that the information submitted is
true and accurate; and
h. The applicant's signature and
date of signature;
2.
A statement signed and dated by the applicant's
clinical fellowship supervisor agreeing to comply with R9-16-210 ;
and
3.
A $100 license renewal fee.
B.
The Department shall review the application packet
for a renewal temporary license to practice as a temporary speech-language
pathologist according to R9-16-209 and Table 2.1.
A. Before the expiration date of a license, a
licensee shall submit to the Department:
1. A
renewal application in a Department-provided format that contains:
a. The licensee's name, home address,
telephone number, and e-mail address;
b. If applicable, the licensee's business
address and telephone number;
c.
The licensee's current employment, if applicable, including:
i. The employer's name,
ii. The licensee's position,
iii. Dates of employment,
iv. The address of the employer,
v. The supervisor's name,
vi. The supervisor's email address,
and
vii. The supervisor's telephone
number;
d. The licensee's
license number and date of expiration;
e. Since the previous license application,
whether the licensee has been convicted of a felony or a misdemeanor in this or
another state;
f. If the licensee
was convicted of a felony or a misdemeanor:
i.
The date of the conviction,
ii. The
state or jurisdiction of the conviction,
iii. An explanation of the crime of which the
licensee was convicted, and
iv. The
disposition of the case;
g. Whether the licensee has had, within two
years before the renewal application date, an audiology or speech-language
pathology license suspended or revoked by any state;
h. If the applicant has been disciplined by
any state, territory, or district of this country for an act related to the
applicant's license to practice audiology or a speech-language pathologist
license that is consistent with A.R.S. Title 36, Chapter 17, documentation that
includes:
i. The date of the disciplinary
action,
ii. The state or
jurisdiction of the disciplinary action,
iii. An explanation of the disciplinary
action, and
iv. Any other
applicable documents, including a legal order or settlement
agreement;
i. An
attestation that the licensee completed continuing education required under
A.R.S. §
36-1904 and documentation of
completion is available upon request;
j. The licensee agrees to allow the
Department to submit supplemental requests for information under
R9-16-214(C)
;
k. An attestation that the
information submitted as part of the application is true and accurate;
and
l. The licensee's signature and
date of signature; and
B. A licensee licensed as a speech-language
pathologist, whose practice is limited to providing services to students under
the authority of a local education agency or state-supported institution, shall
provide documentation required in A.R.S. §
36-1940.01(B);
C. If a licensee is renewing a temporary
speech-language pathology license:
1. A
statement signed and dated by the licensee's clinical fellowship supervisor
agreeing to comply with
R9-16-209 ; and
2. The name, business address, telephone
number, and license number of the speech language pathologist providing
supervision to the licensee.
D. In addition to subsection (A), a licensee
who submits a renewal application within 30 calendar days after the license
expiration date shall submit a late fee specified in
R9-16-216.
E. A licensee who does not submit the
documentation and the fee in subsection (A) and, if applicable, (B) within 30
calendar days after the license expiration date shall apply for a new license
in
R9-16-202.
F. If a licensee applies for a license
according to
R9-16-202 more than 30 calendar
days but less than one year after the expiration date of the applicant's
previous license, the applicant:
1. Is not
required to submit ETSNEA or ETSNESLP documentation, and
2. Shall submit an attestation of continuing
education according to
R9-16-208, completed within the
twenty-four months before the date of application.
G. The Department shall review the
application for a renewal license according
R9-16-214 and Table 2.1.
