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