New Hampshire Code of Administrative Rules
Int - Board of Licensing for Interpreters of the Deaf and Hard of Hearing
Chapter Int 300 - APPLICATIONS FOR LICENSURE
Part Int 301 - LICENSURE
Section Int 301.02 - Application Form

(a) The applicant's full name and address;

(b) Birth date;

(c) The highest level of education attained and the name of the institution(s) that awarded the degree(s);

(d) A statement as to whether the applicant:

(e) A statement as to whether the applicant is currently or has been licensed, certified, or approved as an interpreter for the deaf and hard of hearing in any other state or jurisdiction or by any other licensing or approval body, and if so:

(f) A statement as to whether the applicant has ever been refused a license or state approval by any licensing or approval body for interpreters and, if so, the name of the board, the date of denial, and the reasons for denial;

(g) A statement as to whether the applicant has been the subject of disciplinary action of any kind by any professional licensing or approval body, or has entered into a settlement agreement or consent decree with any such licensing or approval body and, if so, the name of the licensing or approval body and a complete description of the misconduct alleged and the discipline or settlement involved;

(h) A statement as to whether, at the time of application, the applicant is the subject of a misconduct investigation or disciplinary proceeding, or is negotiating a settlement of any misconduct allegations, with any professional licensing or approval body in any jurisdiction and, if so, the name of the licensing or approval body and a complete description of the misconduct alleged or the settlement involved;

(i) A statement as to whether the applicant has ever been convicted of a felony or misdemeanor that has not been annulled and, if so, the name of the court, the details of the offense, the date of conviction and the sentence imposed;

(j) A recent, unretouched photograph of the applicant no larger than 4"x 6";

(k) Cash, a check, or a money order in the amount of the application fee required by Table 303.1. The check or money order shall be made out to the Treasurer, State of New Hampshire;

(l) A declaration that the applicant shall practice ethically and within the rules and laws governing the profession of interpreting;

(m) A declaration that the applicant shall comply with all of the rules of the board, specifically including those governing licensing renewals and requirements for continuing education required by Int 401 and 402;

(n) A declaration that the applicant is the person identified in the application and that all information contained in the application is true and correct; and

(o) The date and signature of the applicant.