New Hampshire Code of Administrative Rules
Ch - Board of Chiropractic Examiners
Chapter Ch 300 - LICENSING REQUIREMENTS
Part Ch 302 - APPLICATION PROCEDURE
Section Ch 302.06 - Effect of Applicant's Signature

(a) States that he or she is applying for a license to practice chiropractic in accordance with RSA 316-A and the rules of the New Hampshire board of chiropractic examiners;

(b) Certifies that he or she is the individual identified in the application and that the submitted photograph is a true likeness of him or her;

(c) Promises that he or she will notify the board in writing within 30 days of any change in the information provided in the application, even after the application has been granted and a license issued;

(d) Consents to the board's use for all purposes of the mailing and electronic addresses provided to the board in the application or thereafter;

(e) Certifies that the information provided on the application form and the documentation provided to support the application are, to the best of knowledge and belief, true, accurate, complete and unaltered; and

(f) Acknowledges that, pursuant to RSA 641:3, I, the knowing making of a false statement on the application form is punishable as a misdemeanor, and that, if he or she knowingly provides the board with any false, inaccurate, incomplete or altered information or documentation, the board has the authority to deny the application or, after a hearing, to take disciplinary action against any license issued to him or her.