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Applications and Forms


APPLY ONLINE for the following license types:

Application for Provisional Licensure as an Audiologist
Application for Provisional Licensure as a Speech-Language Pathologist
Current ASHA Certification
Speech-Language Pathology by Education, Experience (CFY) and Examination (Praxis)
Audiology by Education and Examination
Current Practitioner
Speech-Language Pathology and Audiology Assistant
Reactivation of Expired/Inactive License


Provider/Sponsor Application for Approval of Continuing Education Courses and Programs (PDF)

Application for Individual Continuing Education Approval for Audiologists and Speech-Language Pathologists (PDF)

The reactivation application has been moved to an online process. To review the requirements and submit your reactivation application online, login to your account at and click the pencil icon next to your license number.

Name and/or Address Change
Verification of licensure to another state - request ONLINE 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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