An applicant for a behavior analyst or an assistant behavior analyst license by credentials must submit

1. (1) a completed application on a form provided by the department; the completed application must include

   1. (A) the personal identification information requested on the form;
   2. (B) information on the applicant's physical and mental health related to the grounds for license refusal, suspension, or revocation in AS 08.15.050;
   3. (C) information on any criminal convictions related to the grounds for license refusal, suspension, or revocation in AS 08.15.050; and
   4. (D) the applicant's fingerprint information described in 12 AAC 77.120(a);
2. (2) the application fee, the fingerprint processing fee, and the license fee specified in 12 AAC 02.390;
3. (3) verification of a current license in another state on a form provided by the department; and
4. (4) proof of current certification as required in AS 08.15.020(a)(4) or (b)(4) as applicable.

(Eff. 12/26/2014, Register 212)

Authority: AS 08.15.020, AS 08.15.080