Speech-Language Pathologists and Audiologists Forms
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Please note the following policy regarding the filing of forms which collect a person's individual information:
"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) revised April 2017 (897KB PDF)
Assistant in Speech-Language Pathology
SPA007 Assistant in Speech-Language Pathology Application (545KB PDF)
SPA013 Speech-Language Pathology Supervisory Responsibility Statement (SRS) revised July 2017 (509KB PDF)
SPA017 Clinical Observation and Experience Form for Speech-Lanuage Pathology Assistant (53KB PDF)
SPA021 Assistant in Speech-Language Pathology Clinical Deficiency Plan (91KB PDF)
Intern in Speech-Language Pathology
SPA008 Intern In Speech-Language Pathology Application revised June 2017 (895KB PDF)
SPA012 Speech-Language Pathology Intern Plan and Agreement of Supervision revised April 2017 (436KB PDF)
SPA015 Speech-Language Pathology Report of Completed Internship Form (86KB PDF)
SPA016 Intern in Speech-Language Pathology Course Work and Clinical Experience Form (84KB PDF)
Intern in Speech-Language Pathology Upgrade to Speech-Language Pathology
SPA010 Upgrade Intern in Speech-Language Pathology Application (88KB PDF)
SPA015 Speech-Language Pathology Report of Completed Internship Form (86KB PDF)
Temporary Certificate of Registration in Speech-Language Pathology
SPA009 Temporary Certificate of Registration in Speech-Language Pathology Application (97KB PDF)
Audiology Application
SPA005 Audiology Application (including ASHA or ABA Waiver) (547KB PDF)
Assistant in Audiology
SPA001 Assistant In Audiology Application (543KB PDF)
SPA011 Report of Completed Training for an Assistant in Audiology (80KB PDF)
SPA018 Assistant in Audiology Supervisory Responsibility Statement (SRS) (47KB PDF) revised January 2017
Intern in Audiology
SPA002 Intern In Audiology Application (543KB PDF)
SPA014 Audiology Intern Plan and Agreement of Supervision (90KB PDF)
SPA019 Report of Completed in Internship in Audiology Form (70KB PDF)
SPA020 Intern in Audiology Course Work and Clinical Experience Form (51KB PDF)
Intern in Audiology Upgrade to Audiologist
SPA004 Upgrade Intern Audiologist Application (93KB PDF)
SPA019 Report of Completed in Internship in Audiology Form (74KB PDF)
Temporary Certificate of Registration in Audiology
SPA003 Application for a Temporary Certificate of Registration in Audiology (96KB PDF)
SPA030 Temporary Certificate Registration Audiology Agreement of Supervision (92KB PDF)
Clinical Deficiency Plan
SPA017 Clinical Observation and Experience Form for Speech-Language Pathology Assistant (53KB PDF)
SPA021 Assistant in Speech-Language Pathology Clinical Deficiency Plan (91KB PDF)
SPA024 Assistant in Speech-Language Pathology Clinical Deficiency Plan Observation Log (179KB PDF)
SPA025 Assistant in Speech-Language Pathology Clinical Deficiency Plan Direct Supervision Log (160KB PDF)
Supervision Forms for Assistant in Speech-Language Pathology
SPA013 Speech-Language Pathology Supervisory Responsibility Statement (SRS) (81KB PDF)
SPA028 Speech-Language Pathology Alternate Supervision Plan revised October 2016 (87KB PDF)
SPA029 Supervision Log for the Licensed Assistant in Speech-Language Pathology (41KB PDF)
Other Forms
SPA026 Speech-Language Pathology and Audiology Notice of Change and Duplicate License Request (78KB PDF)
SPA027 Speech-Language Pathology and Audiology License Verification Form (50KB PDF)
TDLR Complaint Sign (19KB PDF)
Disciplinary Action Questionnaire (98KB PDF)
Criminal History Questionnaire (63KB PDF)
Military Service Member, Military Veteran, or Military Spouse Supplemental Application (110KB PDF) - see Military Spouse Frequently Asked Questions
Request to Executive Director for Expired License Renewal (56KB PDF)