Speech-Language Pathology Licensure Forms



|Speech-Language Pathology Licensure Checklists |

|CEY CHECKLIST FOR SPEECH | |CHECKLIST FOR FULL SLP LICENSURE WITH ASHA C'S  |

|Forms | | Forms |

|Application | |1. Application |

|Background Check Application (after June 24, 2010) | |2. A recent Polaroid or passport quality and size photograph of you. |

|3. CEY Plan | |3. A check or money order for $75.00, $85.00 after June 24, 2010 payable to the Board |

|4. CEY Letters of Agreement | |of Examiners for Speech Language Pathology and Audiology. DO NOT SEND CASH! |

|5. Academic Verification Form SLP | |4. Reference Form (three needed)  |

|6. Non-accredited college or University Academic Form | |A letter from ASHA confirming current ASHA C’s. |

|7. Non-accredited college or University Practicum Form | |Background Check Application (after June 24, 2010) |

|8. Reference Form (three needed) | | |

|Report of Clinical Experience | |_______________________________________________________ |

| | | |

|Once your CEY is completed please follow the list below. | |CHECKLIST FOR LICENSURE FROM ANOTHER STATE |

| | | |

|Application (you do not need to fill out a new application form if all| |1. A completed, signed and notarized Application for Licensure Form. |

|the information on your first application is current) | |2. A recent Polaroid or passport quality and size photograph of you. |

|  | |3. A check or money order for $75.00, $85.00 after June 24, 2010 payable to the Board |

|Report of Clinical Experience | |of Examiners for Speech-Language Pathology and Audiology. DO NOT SEND CASH! |

|  | |4. A letter of Verification of licensure from the State you are leaving. |

|Praxis (office will need an original) | |A minimum of three References, one from each of the referees listed on the application, |

| | |should be sent directly to the Board. Referees must either hold the ASHA C.C.C., the |

| | |Oklahoma license in Speech-Language Pathology or Audiology |

| | |Official Transcripts (s) of your pertinent undergraduate and graduate education, with |

| | |Masters degree posted. The transcript must be sent directly by each college or |

| | |university where the course work was completed. |

| | |A copy of your current States rules to document academic and practicum requirements. |

| | |Background Check Application (after June 24, 2010) |

| |

|CHECKLIST OF ASSISTANT FORMS  |

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|Assistant Application Forms  |

|Passport size photo |

|3. Citizenship Form |

|Transcript |

|Background Check Application (after June 24, 2010) |

|A check or money order for $75.00, $85.00 after June 24, 2010 payable to the |

|Board of Examiners for Speech-Language Pathology and Audiology. DO NOT SEND CASH! |

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