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Ky.gov An Official Website of the Commonwealth of Kentucky
Kentucky Board of Speech-Language Pathology & Audiology

Board of Speech-Language Pathology & Audiology
Applications and Forms

Adobe Required
Note: The documents on this page are in Adobe Acrobat (PDF) format. Please click on the following link to download a free copy of Adobe Acrobat Reader.

All applications and documentation requiring review by the Board must be in the Board Office 10 days prior to the scheduled Board meeting or they will not be reviewed.  They will be held and reviewed at the next scheduled meeting.

 

 Forms Library

 
  
  
  
collapse Order : 1 ‎(2)
collapse Category : Speech-Language Pathology & Audiology ‎(2)
Application for Reinstatement.pdf
  
270 KB
Application for Licensure as a Speech-Language Pathologist or Audiologist.pdf
  
107 KB
collapse Order : 2 ‎(3)
collapse Category : Interim Speech-Langauge Pathology ‎(1)
Application for Interim Licensure.pdf
  
163 KB
collapse Category : Interim Speech-Language Pathology ‎(2)
Application for Extension of Interim License.pdf
  
131 KB
Change in Supervision and-or PPE Setting.pdf
  
185 KB
collapse Order : 3 ‎(8)
collapse Category : Audit Renewal Application for Speech-Language Pathologists or Audiologists ‎(1)
Audit Renewal Application for Speech-Language Pathologists or Audiologists.pdf
  
302 KB
collapse Category : Audit Renewal Application for Speech-Language Pathology Assistants ‎(1)
Audit Renewal Application for Speech-Language Pathology Assistants.pdf
  
280 KB
collapse Category : Speech-Language Pathologists or Audiologists ‎(1)
Renewal Application for Speech-Language Pathologists or Audiologists.pdf
  
299 KB
collapse Category : Speech-Language Pathology Assistants ‎(5)
Application for Interim License - SLP-A.pdf
  
346 KB
Application for License as a Speech-Language Pathology Assistant.pdf
  
122 KB
Change in Supervision - SLPA.pdf
  
187 KB
Post Graduate Professional Experience Report and Evaluation Form for Interim SLP-A.pdf
  
213 KB
Renewal Application for Speech-Language Pathology Assistant.pdf
  
277 KB
collapse Order : 5 ‎(5)
collapse Category : Other Forms ‎(5)
Application for Continuing Education Approval.pdf
  
101 KB
Complaint Form.pdf
  
32 KB
Open Records Request.pdf
  
35 KB
Application for License Verification.pdf
  
45 KB
Mailing List Request.pdf
  
22 KB