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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. 7/1/13
Application for Conditional Licensure PDF  Licensure application for SLPs and Audiologists in their CFY. 7/1/13
Conditional License Renewal / Upgrade to Regular Licensure PDF Form to renew conditional licensure after initial year or to upgrade to a regular license 7/1/13
Application for Speech-Language Pathology Assistant Certificate PDF  Certification application for Speech-Language Pathology Assistants. 7/1/13
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

Consumers & the Public
Click on either DOC (MS Word document) or PDF (Adobe Acrobat) in the format field to download the selected form.



Form  Format  Description  Last Updated 
Consumer Complaint Form PDF Form to make a complaint to the Board about a practitioner 6/7/05
Licensee List request PDF  Form to request a list of licensees in various formats. 9/20/10

Downloading Assistance
If you have any difficulty downloading these files, please contact our office.