An applicant for reciprocity endorsement shall submit the following items that shall be received by the Board three weeks prior to the next scheduled Board Meeting posted on the Board's website:

1. (1) a completed application;
2. (2) a resume;
3. (3) certified college transcript(s);

4. (4) three reference forms (one employer and two character) located on the Board's website as set forth in Rule 21 NCAC 37D .0203:

   1. (a) the Employer Reference Form shall include the address of employment and duties assigned; and
   2. (b) the Character Reference Form shall include how the individual knows the applicant and whether the applicant is capable of supervising the care of residents of a skilled facility. No character reference shall be from a relative of the applicant.
5. (5) a licensing questionnaire(s) from every state where the applicant held a license. The questionnaire is available on the Board's website;
6. (6) a non-refundable processing fee of three hundred dollars ($300.00); and
7. (7) a fingerprint card, necessary forms, and required fee for criminal background check. The forms and fees for the criminal background check is available in the Board office and on the Board's website.

History Note: Authority G.S. 90‑280; 90‑285; 90‑287; 90-288.01;
Eff. February 1, 1976;
Readopted Eff. December 15, 1977;
Amended Eff. February 1, 1980;
Readopted Eff. October 1, 1981;
Amended Eff. August 1, 1995; August 2, 1993; February 1, 1991; May 1, 1989;
Transferred and Recodified from 21 NCAC 37A .0912(b) Eff. April 1, 1996;
Amended Eff. April 1, 1996;
Temporary Amendment Eff. August 15, 1999;
Amended Eff. July 1, 2014; July 1, 2004; July 1, 2000;
Readopted Eff. October 1, 2015;
Amended Eff. January 1, 2021.