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Applications and forms

 

licensure

Current ASHA Certification (PDF)

Speech-Language Pathology by Education, Experience (CFY) and Examination (Praxis) (PDF)

Audiology by Education and Examination (PDF)

Reciprocity (PDF)

Current Practitioner (PDF)

 

APPLY ONLINE for the following license types:

Application for Provisional Licensure as an Audiologist
Application for Provisional Licensure as a Speech-Language Pathologist
 
 

reactivation

Reactivation Application (PDF) (for an INACTIVE or EXPIRED license)

 

Additional Applications

Speech-Language Pathology and Audiology Assistant (PDF) 

Approval of Continuing Education (PDF) 

 

forms  

Current Pennsylvania Employer Form (PDF)

Name and/or Address Change (PDF)

NOTE:  As a result of document fraud and in an effort to protect its licensees, the Board will only provide direct source verification of your license to another state licensing agency.

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