Licensee Forms
Misc. License Forms
- Address and Email Change
- Application to Supervise a Hearing Aide Dispenser Trainee
- Application for Branch Office License (Hearing Aid Dispensers and Dispensing Audiologists)
- Application for Multiple Branch Office Licenses (Hearing Aid Dispensers and Dispensing Audiologists)
- Fieldwork Experience Verification Form
- Fieldwork Experience Verification Form Undergraduate Clinical Experience
- License Verification (HAD - DAU)
- License Verification (AU - SLP - SPLA - AIDE)
- Licensee Conviction and Discipline Reporting Form
- Applicant Discipline Reporting Form
- Name and Gender Change Notification and Request for Confidentiality (SB 372, 2023)
- Name Change
- Reactivating a License
- Replacement License
- RPE Extension Application
- RPE Performance Review Form
- RPE Change in Supervision or Work Plan
- RPE Clinical Practicum/University Recommendation Form
- RPE Verification Form
- Subject Matter Expert Application for Enforcement Cases
- Responsibility Statement for Supervisors of a SLPA
- Termination of Supervision for SLPA
- Termination of Supervision for Hearing Aid Dispenser Trainee
- Termination of Supervision for RPE
- Written Re-Examination Application Hearing Aid Dispensing