License Certification

Audiologist, Speech-Language Pathologists, & Speech-Language Assistants

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This form must be completed to request verification of your license to another state or entity. If you are requesting more than one License Verification, please submit a separate form for each request. All requests must include the $25.00 processing fee per request, which may be submitted by either check or money order. You may include one check for multiple requests.

• Request for License Verification (Audiologist, SLP, SLP Assistants, SLP or Audiology Aides) (PDF)

Hearing Aid Dispensers & Dispensing Audiologists

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This form must be completed to request verification of your license to another state or entity. If you are requesting more than one letter, please submit a separate form for each request. All requests must include the $15.00 processing fee, which may be submitted by either check or money order. You may include one check for multiple requests.

• Request for License Verification (Hearing Aid Dispensers and Dispensing Audiologists) (PDF)