To qualify for a teacher's license to practice dentistry, an applicant shall meet the requirements set forth in Health Occupations Article, §4-302, Annotated Code of Maryland. An applicant for a teacher's license to practice dentistry shall submit the following to the Board: A completed application on a form provided by the Board; A photograph of the applicant not to exceed 3 inches by 3 inches accompanied by a notarized statement that “the photograph is a true photograph of me” ; Certified proof of dental education with the raised embossed school seal certifying its authenticity, except that letters from educational institutions on original letterhead and bearing an original signature do not require a raised embossed seal; A certified letter with a raised embossed seal from the dental licensing authority of each state in which the applicant holds an active dental license or ever held an active dental license, indicating that the license is or was in good standing, and that the applicant: Is not being investigated; Does not have charges pending against the applicant's license; Has not been disciplined; and Has not been convicted or disciplined by a court of any state or country for an act that would be grounds for disciplinary action under Health Occupations Article, §4-315, Annotated Code of Maryland; Proof satisfactory to the Board that the applicant has at least 5 years of active dental experience; A copy of the applicant's National Practitioner Data Bank file; A letter from the Dean of the college or university in which the applicant is to teach a subject required by the dental school of that college or university: Requesting that the license be issued; and Indicating that the applicant is to be a full-time faculty member; Documentation of a change of name if the name on any of the documents submitted to the Board differs from the applicant's name; and Any other documents or information pertinent to licensure required by the Board. The practice of dentistry in the armed forces, state and federal programs, and intern and residency programs within the 5 years preceding application shall count toward the required active dental experience.