Board of Examiners for Speech-Language Pathology and Audiology

SLPA Forms

Licensees are not required by any Oregon statute and/or administrative rule to use this specific form. This form is being provided by the Board to serve as an example for licenses of how a submitted form may appear. The Board does not endorse, or take responsibility for, the use of this form by licenses. Licensees may tailor this form or create their own form/format, as long as it complies with, and contains the information required by, OAR 335-095-0065. It is the responsibility of each individual licensee to evaluate their submissions for accuracy, and compliance with any governing statute and/or administrative rule.

 

Example Supervision Plan BSPA

Example Consultative Log

Example Competency Rating Scale for SLPAs

 

SLPA Supervisor Change Form

This is the required reporting form. All changes in supervision must be reported to the Board office within 30 days of any change. Form can be submitted by fax or email attachment.

Coming in 2020, you will be able to submit supervision changes through the new online Licensee Portal. Check back later.

 

Conditional SLP Forms

C-SLP Site or Supervision Change Form

All changes in supervision must be reported to the Board office within 30 days of any change. Form can be submitted by fax or email attachment.

 

Clinical Fellowship Report & Rating Form (ASHA Form)

For upgrading to the regular SLP license see our application page.