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.