NOTARIZED APPLICATION: The seven page application must be mailed to the Board’s
office at the address listed above, along with your $40 non-refundable application fee. All questions must be answered. Any question answered “yes” requires further documentation to be submitted. Attach copies of official court documents and an explanation if you have had any criminal convictions or charges, or sanctions by another state licensing board. Approval of licensure is at the Board’s discretion.
EDUCATIONAL REQUIREMENTS: The applicant must submit a copy of the high school
diploma, GED Certificate or college transcript.
JOB DESCRIPTION: A job description listing the specific duties of the Speech-Language
SUPERVISOR’S DUTIES: The supervisor must retain two years of documentation of the
indirect or direct supervisory activities. This documentation may be requested during a