Section 844IAC6-3-4. Applications for licensure as a physical therapist or certification as a physical therapist's assistant

   (a) Persons desiring licensure as a physical therapist or certification as a physical therapist's assistant must file a completed application on a form provided by the committee.

  (b) Persons submitting a completed application may be issued a temporary permit as provided by IC 25-27-1-8(d).

  (c) At the time of submitting an original application to the committee, the applicant shall show to a staff member of the bureau, or to a member of the committee, the original physical therapist's or physical therapist's assistant's diploma or a certified copy of the diploma. A photocopy of the diploma may then be made for the files of the committee. In the event that such diploma has been lost or destroyed, the applicant shall submit the following:

(1) A statement under the signature and seal of the dean of the school from which the applicant graduated verifying that the applicant has satisfactorily completed:

(A) the prescribed course of study;

(B) the actual degree conferred; and

(C) the date the degree was conferred.

(2) An affidavit made before a duly authorized official to administer oaths, fully and clearly stating the circumstances under which the applicant's diploma was lost or destroyed.

  (d) The fee for an application as specified in 844 IAC 6-2-2 shall be made payable to the health professions bureau. The fee is nonrefundable if the applicant should decide to withdraw the application. (Medical Licensing Board of Indiana; 844 IAC 6-3-4; filed Mar 10, 1983, 3:59 p.m.: 6 IR 775; filed Oct 17, 1986, 2:00 p.m.: 10 IR 433; filed Aug 6, 1987, 3:00 p.m.: 10 IR 2733; filed Sep 22, 1994, 4:30 p.m.: 18 IR 265; readopted filed Nov 9, 2001, 3:16 p.m.: 25 IR 1325; filed Aug 26, 2004, 10:20 a.m.: 28 IR 204; readopted filed Nov 17, 2010, 9:48 a.m.: 20101215-IR-844100405RFA)