Authority: IC 25-8.5-2-6

Affected: IC 25-8.5-3-2

Sec. 2. (a) An applicant for licensure as an assistant behavior analyst shall provide the board with the information required in IC 25-8.5- 3-2 and the following:

1. (1) A completed application.
2. (2) The fee required by section 4 of this rule.

3. (3) Demographic information, including:

   1. (A) name;
   2. (B) date of birth;
   3. (C) Social Security number;
   4. (D) contact information;
   5. (E) citizenship information;
   6. (F) military history;
   7. (G) employment history;
   8. (H) gender; and
   9. (I) other states of licensure.
4. (4) Information regarding fitness for practice, including disciplinary, criminal, and substance abuse history.

5. (5) A statement from the appropriate agency in each state where the applicant has been licensed, certifying whether disciplinary proceedings:

   1. (A) have ever been initiated; or
   2. (B) are presently pending;
6. against the applicant.
7. (6) A signed contract with an LBA, and approved by the BACB, to provide supervision under 844 IAC 21-4- 6.

(b) The committee shall verify with:

1. (1) the BACB, or its successor; or
2. (2) another entity approved by the committee;

that the applicant is currently certified in good standing as a BCaBA.

(Medical Licensing Board of Indiana; 844 IAC 21-2-2; filed Mar 11, 2025, 11:38 a.m.: 20250409-IR-844240437FRA)