a) An applicant for licensure as a perfusionist shall file an application on forms provided by the Department. The application shall include:

1. 1) Certification of graduation from a school accredited by the Commission on the Accreditation of Allied Health Education Programs (CAAHEP) or a similar accrediting body approved by the Department;
2. 2) Certification of successful completion of the examinations provided by the American Board of Cardiovascular Perfusion (ABCP) or its successor agency or a substantially equivalent examination approved by the Department;
3. 3) A work history since graduation from a perfusion program;

4. 4) Vertification from the state in which an applicant was originally licensed and is currently licensed, if applicable, stating:

   1. A) The time during which the applicant was licensed in that state, including the date of the original issuance of the license; and
   2. B) Whether the file on the applicant contains any record of disciplinary actions taken or pending; and
5. 5) The fee required in Section 1335.20 of this Part.

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.