Board of Examiners in Speech-Language Pathology and Audiology

Message To LLR Stakeholders About Regulatory Review Process

Applications/Forms

The following files are in portable document format (PDF) and require the Adobe Acrobat Reader to view and print.

Change of Address Request

Check the Status of Your Application

Complaint Form

Fee Schedule

License Verification Request

Licensee List Request - See fee schedule for appropriate fee

Name Change Request Form

Speech-Language Pathologist or Audiologist

• Application Instructions and Addenda
• Application Form
• Reinstatement Form
• Reactivation of License Form (For individuals who requested to have their license placed on inactive status)

Speech-Language Pathology and Audiology Intern

• Application Instructions
• Application Form
• Clinical Clock Hours Report
• Supervisory Agreement
• Intern Plan and Agreement of Supervised Professional Employment
• Report of Completed Internship
• Intern License Renewal Form

Speech-Language Pathology Assistant

• Application Instructions and Practice Information
• Application Form
• Clinical Clock Hours Report
• Supervisory Agreement
• Projected On-the-Job Training Plan (OJT Plan)
• Quarterly Review