New Hampshire Code of Administrative Rules
Phy - Governing Board of Physical Therapists
Chapter Phy 400 - CONTINUED STATUS
Part Phy 403 - REINSTATEMENT OF LICENSES
Section Phy 403.08 - Supporting Materials

(a) A recent passport size, 2" x 2", original head shot photograph;

(b) On a separate sheet, a detailed report of the relevant circumstances if any of the answers to the "yes-no" questions on the confidential part of the application form is in the affirmative;

(c) On a separate sheet, a detailed report of the relevant circumstances if any of the answers to the "yes-no" questions on the non-confidential part of the application form is in the affirmative;

(d) A completed work history form provided by the board;

(e) An original, not a photocopy, of a criminal offender record report:

(f) Unless the information sought is available only on a website, an official letter of verification sent directly to the board from every state which has issued the applicant a license or other authorization to practice physical therapy since the lapse of the New Hampshire license, stating:

(g) A written statement that the reinstatement applicant has not engaged in physical therapy in New Hampshire on a volunteer or paid basis since the date that his or her license ceased to be valid;

(h) If applicable to the reinstatement applicant, proof in accordance with Phy 407 of having completed 24 hours of continuing education earned within the immediately preceding 2 years of submission of a completed application;

(i) If the reinstatement applicant re-took and passed the national examination in order to meet the requirement in Phy 403.06(b), the applicant's examination scores sent directly to the board by FSBPT;

(j) If the reinstatement applicant is eligible for conditional reinstatement, the completed supervision form described in Phy 404.05;

(k) The original, completed, jurisprudence examination provided to the applicant by the board; and

(l) Transcripts as described in Phy 303.01(c)(1) or (c)(3) if not previously submitted.