1. (a) Individuals seeking to provide supervision pursuant to Alc 405.03 (d) and (e) and Alc 406.02 (b) and (c) shall complete and submit the “Approved Supervisor Application” form, to the OPLC prior to providing such supervision.

2. (b) The “Approved Supervisor Application” shall require the applicant to provide the following information:

   1. (1) Applicant’s full legal name;
   2. (2) Applicant’s license type and license number;
   3. (3) Applicant’s home mailing address;
   4. (4) Applicant’s telephone number;
   5. (5) Applicant’s e-mail address;
   6. (6) Applicant’s employer’s name;
   7. (7) Applicant’s employer’s mailing address;
   8. (8) Applicant’s employer’s physical address;
   9. (9) Applicant’s employer’s telephone number; and
   10. (10) Answer the questions described in Plc 304.03(e).
3. (c) The applicant shall sign and date the “Approved Supervisor Application” as required by Plc 304.05.

4. (d) The applicant shall provide the following with the “Approved Supervisor Application”:

   1. (1) A detailed explanation of any yes answer to the questions required by Alc 407.02(b)(10);
   2. (2) Evidence of successful completion of the IC&RC examination; and
   3. (3) The fee required by Plc 1002.03.
5. (e) The OPLC shall approve any supervisor application that demonstrates the applicant meets the eligibility requirements found in Alc 407.
6. (f) An approved supervisor seeking to retain their approval status shall maintain active status for the New Hampshire license upon which they received their supervisory approval.
7. (g) The OPLC shall maintain an updated list of supervisors who are currently approved to provide supervision to individuals certified or licensed by the OPLC.

Source. #12548, eff 7-1-18; ss by #14045, eff 10-7-24