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Application Forms

Some forms issued by the Speech-Language Pathology and Audiology Board are made available in portable document format. A document in this format is called a PDF file, and has the file extension .pdf after the file name. A free software program called Adobe® Acrobat® Reader is available which will read PDF files so that they can be printed by a person accessing our web site. Acrobat Reader may be obtained by selecting this link. Any person who is blind or visually impaired and who cannot access our PDF files with their web browser may contact the Access Adobe site.

Pursuant to Ohio Administrative Code, Section 4753-5-01 (B): When an initial license is issued less than one hundred days before December 31st of the renewal year, the board shall waive the renewal fee and the license shall be considered to have been issued in the next renewal cycle for purposes of the continuing education requirements of rule 4753-4-01 of the Administrative Code.

Application Forms/Materials in .pdf format for downloading:

  1. General Application Forms

  2. Non-resident Temporary Practice

  3. Business filings are not due in 2017; no filing is required. The Board will post the business filing form on February 1, 2018, which will be due by March 1, 2018

  4. Employment Verification Form

  5. Late Renewal Forms for the 2017-2018 practice period - Please visit our "License Renewal" page at:
    Note: Renewal Deadline was midnight, December 31, 2016

  6. 2017 Margaret M. Roberts Leadership Award - Nomination Form Deadline: April 1, 2017.

    The Board would like to congratulate audiologist, Robert G. Glaser for being selected to receive this award for 2016.

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