a) Pursuant to Section 60 of the Act, an applicant may apply for licensure by filing an application on forms provided by the Department. The application shall be postmarked no later than November 1, 2002 and shall include:

1. 1) Verification of at least 5 years experience in the practice of perfusion. The experience shall be:

   1. A) in operating cardiopulmonary bypass systems during cardiac surgical cases in a licensed health care facility;
   2. B) the primary function of the applicant;
   3. C) a minimum of 200 cases completed in the 5 years between January 1, 1991 and January 1, 2000; and
   4. D) documented by 3 affidavits signed by either cardiovascular surgeons certified by the American Board of Thoracic Surgery or certified American Board of Cardiovascular Perfusion perfusionists who acted in a supervisory capacity;
2. 2) A complete work history since January 1, 1991; and
3. 3) The required fee set forth in Section 1335.20.

b) When the accuracy of any submitted documentation or the relevance or sufficiency of the course work or experience is questioned by the Department or the Board because of lack of information, discrepancies or conflicts in information given, or a need for clarification, the applicant seeking licensure shall be requested to:

1. 1) Provide information as may be necessary; and/or
2. 2) Appear for an interview before the Board to explain the relevance or sufficiency, clarify information or clear up any discrepancies or conflicts in information.