Board of Examiners for Speech-Language Pathology and Audiology

SLPA Forms

SLPA Supervision Log

Logs must be kept per month, per caseload. There should not be more than one supervisor per log. This is a sample form, SLPAs can use other formats if they meet all supervision documentation requirements. See all the SLPA supervision rules here.

 

SLPA Supervisor 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.

 

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. 

 

Professional Development

PD Log for Reporting Activities when Selected for Audit

If you are selected for PD audit during renewals, you must submit a log along with valid documentation of attendance. Un-official ASHA/AAA/ABA transcripts are acceptable documentation. Audit submission can be submitted by fax or email. Audit submissions received after the renewal deadline of 12/31/19 are subject to additional delinquent fees.