(a) A licensee or registrant in current status seeking
modification of a prior Board Order may submit a written application
for modification of the Board Order. The application shall be submitted
to the General Counsel of the Board and shall include at least the
following:
  (1) specific sanction of which modification is requested;

  (2) evidence of compliance with past and current Board
Orders;
  (3) summary of reasons for request;
  (4) benefit to the public if granted; and
  (5) exhibits or testimonials, including but not limited
to any continuing education or other rehabilitative activities.