| License Description |
If there is a positive response the license will not be issued until it has been reviewed by the Medical Licensing Board. In compliance with IC 4-1-6, this agency is notifying all applicants that they must provide the requested information or the application will not be processed. The applicant has the right to challenge, correct, or explain information maintained by this agency. The information provided will become public record. Examination scores and grade transcripts are confidential except in circumstances where their release is required by law. A social security number is being requested by this state agency in accordance with IC 4-1-8-1. Disclosure is mandatory, and this record cannot be processed without it. When submitting a notarized copy of an original document, the notary MUST make a statement to the fact that the notary has seen the original document. If this is not done the document will NOT be accepted. Please view the statute and rules on our website as listed on the following link: http://www.in.gov/pla/bandc/iaac/statruls.html. The Board accepts programs approved by the National Acupuncture Detoxification Association. Their website is www.acudetox.com. (To reinforce the notarized copy information listed on the previous page: When submitting a notarized copy of an original document, the notary MUST make a statement to the fact that the notary has seen the original document. If this is not done the document will NOT be accepted.) Please type or legibly print when completing the application. All information requested on the application must be completed. The application must have an original signature and date. The applicant must submit one (1) passport quality photo taken with in the past three (3) months. The applicant must submit an application fee in the amount of $10.00; payable to Indiana Professional Licensing Agency. All fees are non-refundable and non-transferable. If the applicant has answered any of the questions on the application "yes" a NOTARIZED AFFIDAVIT detailing the occurrence/situation, the outcome, date of occurrence must be submitted. If it is a malpractice payment please include the amount paid. If applicable please submit copies of all court documents and/or arrest records. Letters from attorneys or insurance companies are not accepted in lieu of a statement. The applicant must request a "License Verification or Letter of Good Standing" from each State/Country in which you currently are or have ever been licensed, certified, or registered in any regulated health profession or occupation. This includes all licenses etc., that are active, expired, inactive, retired, delinquent etc. In addition to any Acupuncture license/permit etc., this also pertains to any professional health license such as an EMT, Chiropractic, Dentist, Podiatrist, etc. The applicant will need to print off the verification form; contact the appropriate entities/States to see if they charge a fee for completing this form and send the form directly to them. They will in turn complete the verification and mail it directly to our office. The verification must come directly from the State or authority in which license was obtained. All applicants must submit a notarized copy of documentation of successful completion of a board approved training program in acupuncture for the treatment of alcoholism, substance abuse, or chemical dependency that meets or exceeds the standards of training by the National Acupuncture Detoxification Association. All applicants must submit a notarized copy of a high school diploma or general education development diploma. All applicants must submit a notarized copy of proof of completion of a clean needle technique course approved by the NCCAOM. All applicants must submit a notarized list of current and previous supervisors. When the name on any document differs from the applicant's name, a notarized or certified copy of a marriage certificate or legal name change must be submitted. |