Current through Register No. 52, December 26, 2024
(a) Any person
who wishes to engage in the practice of massage therapy shall first complete
and submit a "Massage Therapist Licensure Application" form for a massage
therapist license.
(b) Each
applicant for licensure as a massage therapist shall complete and submit a
"Massage Therapist Licensure Application" form for licensure which contains the
following:
(1) The applicant's legal
name;
(2) The applicant's home and
mailing address;
(3) The
applicant's email address;
(4) The
applicant's home telephone and cell phone number;
(5) A recent 2" x 2" photograph of the
applicant's face;
(6) The
applicant's date or birth;
(7) The
applicant's social security number as required by
RSA
161-B:11, VI-a;
(8) The name and address of the massage
therapy schools attended, enrollment date, and graduation date;
(9) An official copy of the diploma or
certificate received from the massage therapy school;
(10) Verification that the applicant has
completed the educational requirements of Plc 902.02, as follows:
a. The applicant shall submit his or her
official school transcripts from the massage therapy school that the applicant
attended; and
b. If any part of the
applicant's massage therapy education was through distance learning, those
courses shall meet the requirements for distance learning in accordance with
Plc 902.02(c);
(11)
Documentation of passage of a written exam in accordance with Plc
902.05;
(12) The name of each state
where the applicant holds or has held a license or certificate to practice
massage therapy and the number of years the applicant has practiced in each
state;
(13) A copy of the
applicant's current first aid certification;
(14) A copy of the applicant's current adult
CPR certification;
(15) A statement
verifying that the applicant is in good mental and physical health in
accordance with RSA
328-B:6, I(d) and, if not,
an explanation of such circumstances;
(16) A statement that the applicant has not
been convicted of any crime involving violence inflicted on a person or
threatened against a person, or any sexually-related crime, in New Hampshire or
any other state in accordance with
RSA
328-B:6, I(c) and, if yes,
an explanation of such circumstances; and
(17) The applicant's dated signature below
the following pre-printed attestation:
"By my signature I attest full compliance with RSA 328-B and
all corresponding New Hampshire regulations and that the information and
documentation provided are accurate to the best of my knowledge. I understand
that knowingly providing false information may be grounds for denial,
suspension, and/or revocation of a license."
(c) The completed application shall be
submitted to the executive director and accompanied by the fee set forth in Plc
908.
