Get Maintenance Record Keeping

Filling out the Maintenance Record Keeping form is an essential part of maintaining your certification in audiology or speech-language pathology. This guide provides clear, step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to fill out the Maintenance Record Keeping form

1. Click the ‘Get Form’ button to obtain the Maintenance Record Keeping form and open it for editing.
2. Enter your name in the designated field to identify yourself on the form.
3. Specify your area of certification by checking the appropriate box for audiology, speech-language pathology, or dually certified.
4. Provide your ASHA ID number in the field provided.
5. Indicate the 3-year maintenance interval by filling in the corresponding dates, ensuring they reflect your certification period.
6. List your professional development activities on separate lines, making sure each activity was completed within your specified 3-year maintenance interval.
7. Calculate the CMHs for each activity based on the provided equivalency (1 CEU = 10 CMHs); be sure to include this information next to each activity.
8. Document the date of completion, sponsoring organization, and the total number of CMHs for each activity listed.
9. Attach all required documentation of participation, including certificates or letters, as necessary to support your activities.
10. Review the entire form for completeness and accuracy before saving your changes. Once finished, you can download, print, or share the form.

Complete your Maintenance Record Keeping form online today to ensure your certification is up-to-date.