Speech-Language Pathologists and Audiologists Forms

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"An individual who completes and files this form with the Texas Department of Licensing and Regulation (the Department) is entitled to the following from the Department:

(1) to be informed about the information that the Department collects about the individual, upon the request of the individual and subject to a few exceptions;

(2) to receive and review the information, under Sections 552.021 and 552.023 of the Texas Government Code; and

(3) to have the Department correct information about the individual that is incorrect, under Section 559.004 of the Texas Government Code."

Speech-Language Pathology Application

SPA006 Speech-Language Pathology Application (including ASHA Waiver) (PDF)

Assistant in Speech-Language Pathology

SPA007 Assistant in Speech-Language Pathology Application (PDF)

SPA013 Speech-Language Pathology Supervisory Responsibility Statement (SRS) (PDF)

SPA017 Clinical Observation and Experience Form for Speech-Lanuage Pathology Assistant (PDF)

SPA021 Assistant in Speech-Language Pathology Clinical Deficiency Plan (PDF)

Intern in Speech-Language Pathology

SPA008 Intern In Speech-Language Pathology Application (PDF)

SPA012 Speech-Language Pathology Intern Plan and Agreement of Supervision (PDF)

SPA015 Speech-Language Pathology Report of Completed Internship Form (PDF)

SPA016 Intern in Speech-Language Pathology Course Work and Clinical Experience Form (PDF)

SPA031 Evaluation of Internship and Intern Plan of Agreement and Supervision in Speech-Language Pathology (PDF)

Intern in Speech-Language Pathology Upgrade to Speech-Language Pathology

SPA010 Upgrade Intern in Speech-Language Pathology Application (PDF)

SPA015 Speech-Language Pathology Report of Completed Internship Form (PDF)

Audiology Application

SPA005 Audiology Application (including ASHA or ABA Waiver) (PDF)

Assistant in Audiology

SPA001 Assistant In Audiology Application (PDF)

SPA011 Report of Completed Training for an Assistant in Audiology (PDF)

SPA018 Assistant in Audiology Supervisory Responsibility Statement (SRS) (PDF)

Intern in Audiology

SPA002 Intern In Audiology Application (PDF)

SPA014 Audiology Intern Plan and Agreement of Supervision (PDF)

SPA019 Report of Completed in Internship in Audiology Form (PDF)

SPA020 Intern in Audiology Course Work and Clinical Experience Form (PDF)

SPA030 Evaluation of Internship and Intern Plan of Agreement and Supervision in Audiology (PDF)

Intern in Audiology Upgrade to Audiologist

SPA004 Upgrade Intern Audiologist Application (PDF)

SPA019 Report of Completed in Internship in Audiology Form (PDF)

Clinical Deficiency Plan

SPA017 Clinical Observation and Experience Form for Speech-Language Pathology Assistant (PDF)

SPA021 Assistant in Speech-Language Pathology Clinical Deficiency Plan (PDF)

SPA023 Assistant in speech-language Pathology Clinical Deficiency Plan Completion of Training and Rating Scale (PDF)

SPA024 Assistant in Speech-Language Pathology Clinical Deficiency Plan Observation Log (PDF)

SPA025 Assistant in Speech-Language Pathology Clinical Deficiency Plan Direct Supervision Log (PDF)

Supervision Forms for Assistant in Speech-Language Pathology

SPA013 Speech-Language Pathology Supervisory Responsibility Statement (SRS) (PDF)

SPA028 Speech-Language Pathology Alternate Supervision Plan (PDF)

SPA029 Supervision Log for the Licensed Assistant in Speech-Language Pathology (PDF)

Other Forms

SPA026 Speech-Language Pathology and Audiology Notice of Change and Duplicate License Request (PDF)

SPA027 Speech-Language Pathology and Audiology License Verification Form (PDF)

TDLR Complaint Sign (PDF)

Disciplinary Action Questionnaire (PDF)

Criminal History Questionnaire (PDF)

Military Service Member, Military Veteran, or Military Spouse Supplemental Application (PDF) - see Military Spouse Frequently Asked Questions

Request to Executive Director for Expired License Renewal (PDF)

Criminal History Evaluation Letter