(1) Retired or nonpracticing dentists and dental hygienists seeking to practice under a volunteer license shall submit a complete application and the following documentation:

(a) verification of graduation from a dental or dental hygiene school accredited by the American Dental Association Commission on Dental Accreditation (CODA) or its successor;

(b) verification of licensure from any other state that the applicant is or has been licensed in;

(c) proof of operative competency by either:

(i) a verified statement that the applicant has actively and competently practiced in Montana or another jurisdiction within the last five years; or

(ii) if the applicant has been out of practice for longer than five years, the applicant shall provide:

(A) proof of completion of a board approved clinical competency course(s) or skills assessment analysis; or

(B) a board approved regional or state examination within the most recent five years.

(d) verification that the applicant has maintained for at least ten years prior to retirement, full licensure in good standing in Montana, another state or jurisdiction, Canada, or the United States armed forces;

(e) a notarized statement that the applicant shall not accept any form of remuneration for any dental or dental hygiene services rendered while in possession of the volunteer license;

(f) provides the name and address of the location(s) where the applicant intends to provide services under a volunteer license to indigent or uninsured patients in underserved or critical need areas;

(g) a copy of a current CPR, ACLS, or PALS card; and

(h) any other information the board may require as evidence of operative competency.

(2) The board shall review applications submitted by applicants with medically diagnosed mental or physical disabilities on a case-by-case basis.

(3) Application material remains valid for six months from receipt in the board office. If the application is not completed within six months a new application and fees must be submitted.

(4) Renewal fees and late fees or a portion of such fees may be waived for eligible persons applying for licensure under this rule after July 1, 2004, upon approval of the board.

(5) Volunteer licenses must be renewed by the date set by ARM 24.101.413.