(1) The applicant for dental hygiene licensure by credentials shall meet the following requirements and submit a completed application. The application must include the following:

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

(b) an original score card from the Joint Commission on National Dental Examinations showing the applicant's passage of the written dental hygiene examination administered by the Joint Commission on National Dental Examinations;

(c) evidence of successful passage of a clinical examination;

(d) license verifications from all jurisdictions where the applicant is licensed or has held a license. If employed by the federal government, the applicant shall submit a letter of explanation for any discipline with the employing federal agency;

(e) proof that the applicant has practiced dental hygiene for a minimum of 1000 hours in the two years prior to application;

(f) a copy of the applicant's current CPR, ACLS, or PALS card;

(g) affidavits from two persons not related to the candidate regarding the applicant's good moral character;

(h) a copy of a self-query of the National Practitioner Data Bank and the Healthcare Integrity Data Bank; and

(i) payment of all appropriate fees including a credentialing fee.

(2) The applicant may not be physically or mentally impaired by use of addictive drugs, alcohol, or any other drug or substance, or by mental or physical illness which in the determination of the board renders the individual unfit or incapable of practicing dental hygiene.

(3) Applicants shall successfully pass the jurisprudence examination with a final grade of at least 75 percent, prior to issuance of a license.

(4) Application material remains valid for one year from the time it is received in the office.