Ariz. Admin. Code § R9-16-502 - Initial Application

A. An applicant for licensure shall submit to the Department:

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

a. The applicant's name, home address, telephone number, 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 in this state or another state;

e. If the applicant has been 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;

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

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

h. Whether the applicant agrees to allow the Department to submit supplemental requests for information under R9-16-506 ;

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 If a license for an applicant has been revoked or suspended by any state, documentation that includes:

a. The date of the revocation or suspension,

b. The state or jurisdiction of the revocation or suspension, 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 licensure, and

c. An explanation of the ineligibility for licensure;

5. Documentation of the applicant's citizenship or alien status that complies with A.R.S. § 41-1080.

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

b. Birth certificate;

c. Naturalization documents; or

d. Documentation of legal resident alien status;

6. A transcript or equivalent documentation 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 specified in A.R.S. § 36.1940.04(A) that requires:

a. No less than 20 semester credit hours of general education, and

b. No less than 20 semester credit hours of speech-language pathology technical course work;

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

8. The application and licensing fees specified in R9-16-508 .

9. A $200 license fee.

B. In addition to complying with subsection (A)(1) through (5), an applicant that may be eligible for licensure under A.R.S. § 36-1922 shall submit documentation to the Department that includes:

1. The name of each state that issued the applicant a current speech-language pathologist assistant, including:

a. The license number of each current speech-language pathologist assistant license, and

b. The date each current speech-language pathologist assistant license was issued;

2. Documentation of the professional license or certification issued to the applicant by each state in which the applicant holds a professional license or certification;

3. For each state named in subsection (B)(1), a statement, signed and dated by the applicant, attesting that the applicant:

a. Has been licensed or certified in another state for at least one year, with a scope of practice consistent with the scope of practice for which licensure is being requested;

b. Has met minimum education requirements according to A.R.S. § 36-1940.04;

c. Has not voluntarily surrendered a license or certification in any other state or country while under investigation for unprofessional conduct; and

d. Does not have a complaint, allegation, or investigation pending before another regulatory entity in another state or country related to unprofessional conduct.

C. A regular license is valid for two years from the date of issue.

B. D. The Department shall review the application and required documentation for an initial license to practice as a speech-language pathologist assistant according to R9-16-506 and Table 5.1.

C. E. If the Department does not issue an initial license to an applicant, the Department shall refund the license fee to the applicant.

Notes

Ariz. Admin. Code § R9-16-502

New Section made by final rulemaking at 15 A.A.R. 2132, effective January 30, 2010 (Supp. 09-4). Amended by exempt rulemaking at 20 A.A.R. 1998, effective 7/1/2014. Amended by final expedited rulemaking at 26 A.A.R. 852, effective 4/8/2020.