Board of Examiners in Speech-Language Pathology and Audiology
Applications/Forms
The following files are in portable document format (PDF) and require the Adobe Acrobat Reader to view and print.
Check the Status of Your Application
License Verification Request
Licensee List Request - See fee schedule for appropriate fee
Paper Applications
Speech-Language Pathologist or Audiologist
- Application Instructions and Addenda
- Application Form
- Reinstatement Form
- Reactivation of License Form (For individuals who requested to have their license placed on inactive status)
Speech-Language Pathology and Audiology Intern
- Application Instructions
- Application Form
- Clinical Clock Hours Report
- Supervisory Agreement
- Intern Plan and Agreement of Supervised Professional Employment
- Report of Completed Internship
- Intern License Renewal Form
Speech-Language Pathology Assistant
- Application Instructions and Practice Information
- Application Form
- Clinical Clock Hours Report
- Supervisory Agreement
- Projected On-the-Job Training Plan (OJT Plan)
- Quarterly Review
Apply Online
- Speech-Language Pathologist Application
- Audiologist Application
- Speech-Language Pathologist Intern Application
- Speech-Language Pathologist Assistant Application
* These forms must be completed and submitted to the Board as part of the online application process.
