AUDIOLOGY

  LICENSURE

  Checklist 

 Please review checklist for all forms needed for application. 

    Form: Full Licensure Application

SPEECH-LANGUAGE PATHOLOGY

                      LICENSURE

                            Checklist 

Please review checklist for all forms needed for application. 

       Form:  Full Licensure Application 

CEY LICENSURE 

Checklist 

    Please review checklist for all forms needed for application.

Form:  Clinical Experience 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

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

  Trak 1 Background Search  

OBESPA Mail-In 

Renewal and Deactivation Forms

Select the form below to print your 

2016 Renewal Form

Deactivation Form

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) 
• Trak 1 Background Search 
• Reactivation of License Form
• Complaint Form
• Continuing Education Form and list of approved CE activities