1. A. An applicant for an athletic trainer license shall submit an original application that includes the following information:

   1. 1. Applicant’s full name;
   2. 2. Applicant’s name as it will appear on the license;
   3. 3. Other names used;
   4. 4. Social Security number;
   5. 5. Residence address and telephone number;
   6. 6. Date of birth;
   7. 7. Applicant’s national athletic training certificate number and date of certification;
   8. 8. Post-secondary educational institutions attended;
   9. 9. Professional experience, field work, or both within the last five years;
   10. 10. Employer’s name, address, and telephone number;
   11. 11. Current or previous athletic training or other professional license or certification numbers from other states and foreign countries and the status of each license or certification;
   12. 12. Current and previous arrest, criminal conviction, and disciplinary actions from any licensing agency or court;
   13. 13. E-mail address;
   14. 14. Alternate email address if the personal email address is to remain confidential;
   15. 15. Statement of citizenship or alien status and submittal of documents showing the individual’s presence in the United States is authorized under federal law;
   16. 16. Signature and date with an attestation regarding the truthfulness of the information provided.

2. B. An applicant shall submit or cause to be submitted on the applicant’s behalf the following:

   1. 1. Application fee,
   2. 2. Written verification from the BOC of athletic training certification or a passing score on the national examination as required by R4-49-201,
   3. 3. A readable fingerprint card and associated fee for submission to the Department of Public Safety or current fingerprint clearance card issued by the Department of Public Safety.
   4. 4. Verification of passing an exam on the athletic training statutes and this Chapter as evidenced by an original notice of examination results.
3. C. An original license shall expire one year from the date of issuance.

Historical Note

New Section adopted by final rulemaking at 7 A.A.R. 1374, effective March 7, 2001 (Supp. 01-1). Section amended by final rulemaking at 19 A.A.R. 361, effective April 6, 2013 (Supp. 13-1). Amended by final rulemaking at 28 A.A.R. 618 (March 18, 2022), effective April 23, 2022 (Supp. 22-1).