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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 business 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
121 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 ‎(4)
collapse Category : Speech-Language Pathology Assistants ‎(4)
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
collapse Order : 5 ‎(4)
collapse Category : Other Forms ‎(4)
Application for Continuing Education Approval.pdf
101 KB
Complaint Form.pdf
32 KB
Open Records Request.pdf
35 KB
Mailing List Request.pdf
22 KB