Audiology 

Full Licensure

Checklist 

 Please review checklist for all forms needed for application. 

            Form: Full Licensure Application

_________________________________

Speech-Language Pathology

Full Licensure 

Checklist 

    Please review checklist for all forms needed for application. 

       Form:  Full Licensure Application   

Speech-Language Pathology Assistant Licensure

 Checklist for SLP Assistants 

 Please review checklist for all forms needed for application. 

Forms:

Application

Academic Requirement 

Clinical Requirement

Letters of Agreement

Reference Letter (3)

Supervision Log

Trak 1 Background Search 

______________________________________

Audiology Assistant Licensure 

Checklist Audiology Assistants 

 Please review checklist for all forms needed for application. 

          Forms:

            Application 

            Citizenship Affidavit

            Letters of Agreement for supervision

            Reference Letter (3)

                Trak 1 Background Search     

General Forms

• Academic Preparation and Practicum Verification Form SLP
• Non-Accredited Institution Practicum Form
• CEY Letters of Agreement
• CEY Plan
• Report of Clinical Experience
• Verification of Citizenship Affidavit
• Verifying Qualified Alien Status Affidavit
• Reference Letter (need three)
• Letter of Agreement for the Supervised Practice Form
• Continuing Education Form and list of approved CE activities
• Academic Preparation Form Fundamental Area
• Trak 1 Background Search
• Reactivation of License Form
• Complaint Form

______________________________________

Speech-Language/Audiology Mail-In Renewal Form

Select the form below to print your 

2013 Mail - In Renewal Form.

Speech-Language Pathology

CEY Licensure 

Checklist 

    Please review checklist for all forms needed for application.

Form:  Clinical Experience Application