Ca board slp supervisors change form

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• Board Vision/Function/Mission Statement
• Board Meetings
• Board Members
• Enforcement
• Strategic Plan
• More.

• Audiology
• Speech-Language Pathology

• Hearing Aid Dispensing
• Continuing Education Course Provider

• Address Change
• Continuing Education
• Criminal Convictions
• Fee Schedule
• More.

• Complaint Process
• Consumer Fact Sheets

• Criminal Conviction Information
• Enforcement
• More.

• Address Change Application
• Name Change
• Occupational Analysis

• Criminal Conviction Information
• Consumer Complaint Form
• Sunset Reports

Forms and Publications

Forms

Application Packages

• Audiologist
• Audiology Aide
• Continuing Education Course / Provider
• Hearing Aid Dispensing
• Speech-Language Pathologist
• Speech-Language Pathology Assistant
• Speech-Language Pathology Aide
• Fingerprint Cards (Out of State Applicants) Hearing Aid Dispensers
• Fingerprint Cards (Out of State Applicants) Speech & Audiology

Miscellaneous Forms for Licensees

• Address and Email Change
• Application to Supervise a Hearing Aide Dispenser Trainee
• Application for Branch Office License NEW Apply Simply! Online Application! (Hearing Aid Dispensers and Dispensing Audiologists)
• Application for multiple Branch Office Licenses(Hearing Aid Dispensers and Dispensing Audiologists)
• Fieldwork Experience Verification Form
• Fieldwork Experience Verification Form Undergraduate Clinical Experience
• License Verification (HAD - DAU)
• License Verification (AU - SLP - SPLA - AIDE)
• Licensee Conviction and Discipline Reporting Form
• Applicant Discipline Reporting Form
• Name and Gender Change Notification and Request for Confidentiality (SB 372, 2023)
• Name Change
• Reactivating a License
• Replacement License
• RPE Extension Application
• RPE Performance Review Form
• RPE Change in Supervision or Work Plan
• RPE Clinical Practicum/University Recommendation Form
• RPE Verification Form
• Subject Matter Expert Application for Enforcement Cases
• Responsibility Statement for Supervisors of a SLPA
• Termination of Supervision for SLPA
• Termination of Supervision for Hearing Aid Dispenser Trainee
• Termination of Supervision for RPE
• Written Re-Examination Application Hearing Aid Dispensing

Downloadable License Application Packages

• Speech-Language Pathologist License
• Option #1 - Required Professional Experience: License Application Package for RPE Temporary License
• Upon completion of 36 full-time weeks (or 72 part-time weeks) of required professional experience under an RPE Temporary License, applicant must submit the Permanent License Application, including the RPE Verification Form: License Application Package for Permanent Licensure as a Speech-Language Pathologist
• Option #2 - Equivalent Qualifications: License Application Package for Equivalent Qualifications
• Option #3 - Licensed in Another State or US Graduate: License Application Package for Current License in Another State
• Option #4 - Previously Licensed in California: License Application Package for Previously Licensed
• Option #5 - License Application Package for Foreign-Educated
• Upon completion of all required weeks of required professional experience under an RPE Temporary License, applicant must submit the Permanent License Application, including the RPE Verification Form: License Application Package for Permanent Licensure as a Speech-Language Pathologist
• Audiologist License
• Option #1 - Required Professional Experience Temporary License for AU.D. students: License Application for Required Professional Experience Temporary License
• Upon completion of 12 months of required professional experience under an RPE Temporary License, applicant must submit the Permanent License Application, including the RPE Verification Form: License Application Package for Permanent Licensure as an Audiologist
• Option #2 - Equivalent Qualifications
• Option #3 - Licensed in Another State or US Graduate: License Application Package for Audiologist Licensed in Another State
• Option #4 - Previously Licensed in California: Previously Licensed in California: License Application Package for Previously Licensed
• Option #5 - License Application Package for Foreign-Educated
• Upon completion of 12 months of required professional experience under an RPE Temporary License, applicant must submit the Permanent License Application, including the RPE Verification Form: License Application Package for Permanent Licensure as an Audiologist
• Speech-Language Pathology Assistant
• Audiology Aide
• Speech-Language Pathology Aide
• Hearing Aid Dispenser
• Option #1 - Application for Written Examination Only - No License Issued (No Dispensing Allowed)
• Option #2 - Application for Hearing Aid Dispenser Trainee Temporary License with Supervision
• Option #3 - Application for Hearing Aid Dispenser Temporary License - Licensed in Another State
• Continuing Education Course Approval or Continuing Professional Development Provider Applications
• Application for Hearing Aid Dispensing Course Approval (HA/DAU)
• Application for Continuing Professional Development Provider License (SLP/AU)

Renewal Forms

• Audiology and Speech-Language Pathology Renewal
• Branch License Renewal
• Dispensing Audiologist License Renewal
• Hearing Aid Dispensers Renewal
• Professional Development Provider Renewal
• Speech-Language Pathology Assistant Renewal

Publications

Consumer Protection

• Consumer Complaint Process with Forms
• Criminal Conviction Information
• Disciplinary Actions with Definitions
• Disciplinary Guidelines and Model Disciplinary Orders - 1997, Hearing Aid Dispensers
• Disciplinary Guidelines - 2004, Speech and Audiology
• DCA Uniform Standards Regarding Substance-Abusing Healing Arts Licensees, March 2019
• Disclosure Policy
• Filing a Complaint

General

• Advertising Guidelines for Hearing Aids
• Board Approved SLPA Programs
• California Newborn Hearing Screening Program and Early Start
• Fee Schedule
• CE Course List
• Hearing Loss and Hearing Aids - Consumer Facts
• Laws and Regulations
• Merger of the Speech-Language Pathology and Audiology with the Hearing Aid Dispensers Bureau
• Occupational Analysis
• State Leadership Accountability Act 2019
• Practice Issues
• Strategic Plan
• Sunset Reports
• Telehealth Technology
• Utilization of Speech-Language Pathologist and Audiologist in Public Schools

News Releases

• August 7, 2018 - Southern California Audiologist Ordered to Cease and Desist Practice
• May 8, 2018 - Tarzana Audiologist Ordered to Cease and Desist Practice
• October 6, 2017 - McDonald Hearing Aid Centers Settlement Agreements Reached

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