Missouri Code of State Regulations
Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE
Division 2150 - State Board of Registration for the Healing Arts
Chapter 8 - Licensing of Clinical Perfusionists
Section 20 CSR 2150-8.010 - Application Forms

(1) The applicant is required to make application upon a form prepared by the board.

(2) No application will be considered unless fully and completely made out on the specified form and properly attested.

(3) An applicant shall present with the application at least one (1) recent unmounted photograph, in a size not larger than three and one-half inches by five inches (3 1/2" x 5"). The photograph must have been taken within the two (2)-year period prior to application.

(4) Applications shall be sent to the executive director of the State Board of Registration for the Healing Arts, P.O. Box 4, Jefferson City, MO 65102.

(5) The board shall charge each person applying for licensure to practice as a clinical perfusionist, either by examination, certification or reciprocity, an appropriate fee established by the board. The fee shall be sent in the form of a bank draft or money order (Personal checks will not be accepted).

(6) In all instances where the board, by rule or in the application form, has provided that it will accept copies in lieu of an original document, the applicant shall provide copies notarized by a notary public to verify that those copies are true and correct copies of the original document. The board will not recognize foreign notaries. The board shall accept the notarization of a United States consul.