Applicants for renewal of their licenses shall submit, or arrange for the OPLC to receive, the following materials:

1. (a) A detailed report of the relevant circumstances if any of the answers to questions from the application form specified in Plc 308.06(e) are in the affirmative;

2. (b) A completed “Physical Therapist and Physical Therapist Assistant Work History Form” requiring the following information for each company or organization worked at:

   1. (1) Applicant’s name;
   2. (2) Date of form completion;
   3. (3) Name of company or organization;
   4. (4) Company or organizations address;
   5. (5) Company or organizations phone number;
   6. (6) Supervisor’s name;
   7. (7) Employment beginning date;
   8. (8) Employment ending date;
   9. (9) Number of hours worked per week; and
   10. (10) Any comments the licensee deems relevant to the work history; and
3. (c) The passing scores on the most recently required New Hampshire jurisprudence assessment module as described in Phy 402.03.

Source. #9456, eff 4-17-09; ss by # 10061, eff 12-23-11; ss by #10203, eff 19-19-12; ss by #10402, eff 8-23-13; ss by #13825, eff 2-17-24 (formerly Phy 402.07)