Speech Language Pathologists and Audiologists Forms
On this page:
Speech-Language Pathologists
SPA006 Speech-Language Pathology Application (including ASHA Waiver) (PDF)
SPA015 Speech-Language Pathology Report of Completed Internship Form (PDF)
SPA016 Intern in Speech-Language Pathology Course Work and Clinical Experience Form (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)
Intern in Speech-Language Pathology Upgrade to Speech-Language Pathologist
SPA010 Upgrade Intern in Speech-Language Pathologist Application (PDF) revised June 2018
SPA015 Speech-Language Pathology Report of Completed Internship Form (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)
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)
Clinical Deficiency Plan for Assistant in Speech-Language Pathology
SPA017 Clinical Observation and Experience Form for Speech-Language Pathology Assistant (PDF)
SPA021 Assistant in Speech-Language Pathology Clinical Deficiency Plan (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)
Audiologists
SPA005 Audiology Application (including ASHA or ABA Waiver) (PDF)
SPA014 Audiology Intern Plan and Agreement of Supervision (PDF)
SPA020 Intern in Audiology Course Work and Clinical Experience Form (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) revised June 2018
SPA019 Report of Completed in Internship in Audiology Form (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)
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)
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
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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."
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