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



Name and/or Address Change

Application for Approval of Continuing Education Courses and Programs (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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