| Form |
Format |
Description |
Last Updated |
Licensing |
| Name / Address Change Report |
PDF |
Form to report change of name or address. |
11/30/10 |
| Application for Licensure |
PDF
|
Licensure application for Speech-Language Pathologists and Audiologists. |
5/1/13 |
| Application for Conditional Licensure |
PDF |
Licensure application for SLPs and Audiologists in their CFY. |
8/18/11 |
| Conditional License Renewal / Upgrade to Regular Licensure |
PDF |
Form to renew conditional licensure after initial year or to upgrade to a regular license |
2/09/11 |
| Application for Speech-Language Pathology Assistant Certificate |
PDF |
Certification application for Speech-Language Pathology Assistants. |
5/1/13 |
| SLPA Clinical Contact Competencies Checklist |
PDF |
Competency Checklist for 100 hours of required clinical interaction |
2/09/11 |
| SLPA Clinical Interaction Log |
PDF |
Example Log Form for recording 100 clinical interaction hours. |
2/09/11 |
| Registration to Supervise SLPAs - no longer needed - see 8/9/10 news flash. |
|
Use the SLPA supervision change notice |
8/9/10 |
Supervision |
Petition for Special Approval for Supervision
of Speech-Language Pathology Assistants
|
PDF |
Education Service Districts and School Districts must use this form to apply for approval for an exception to the usual requirements for Direct Supervision of SLPAs by licensed SLPs. |
8/18/08 |
| Supervision Change (or adding new) Notice |
PDF |
For SLPAs to report changes (adding additional supervisor, replacing supervisor, removing supervisor) in supervisors. |
10/21/11 |
| Smart Form for Supervision of SLPAs in Clinical Interaction |
|
Questions and Answers (PDF)
Blank Smart Form (DOC)
|
10/14/11 |
Professional Development |
| Professional Development Activity Special Approval - Licensee(s) |
PDF |
Application for special approval of a professional development activity for licensees wanting PD credit. |
4/22/13 |
| Professional Development Activity Special Approval - Sponsor(s) |
PDF |
Application for special approval of a professional development activity for Sponsors/providers of PD activities. |
4/22/13 |
| Professional Development Report Form |
PDF |
Form for reporting completed professional development to the board. |
8/5/08 |
Miscellaneous |
| Verification of License request to submit to other Jurisdiction |
PDF |
This is to request verification of your license from OTHER JURISDICTIONS (not OR) to be sent to Oregon. |
4/1/09 |
| Sample Hearing Aid Purchase Agreement |
DOC |
Sample Agreement for Audiologists |
4/13/12 |
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