Get Or Application For Provisional Speech-language Pathology Assistant (slpa) Certificate 2013-2026

Filling out the OR Application For Provisional Speech-Language Pathology Assistant (SLPA) Certificate online is a critical step toward obtaining your provisional license. This guide will walk you through the necessary sections and provide clear instructions to help you successfully complete the application process.

Follow the steps to fill out your SLPA certificate application online:

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering your personal contact information, including your name, date of birth, email, and Social Security number. Ensure that all details are accurate and match your official documents.
3. Provide your home address and current work address, if applicable. Be sure to check the box to indicate your preferred address for Board correspondence.
4. Complete the education section by listing your attended schools, the number of credits earned, and whether you have requested official transcripts.
5. Fill in your supervisor information, including their name and license number. If you have multiple supervisors, make sure to include all relevant details.
6. Document your work experience over the past five years, detailing employers, positions held, and dates of employment.
7. Respond to the ethnicity and bilingual information questions. Providing this information is optional and will not affect your application.
8. Carefully read and initial each statement in the Clinical Fieldwork Contract. Ensure that both you and your supervisor sign this section.
9. Answer all questions in the Criminal/Adverse Professional History section truthfully, providing additional documentation if needed.
10. Review the Certification and Affidavit section, ensuring you understand and agree to pursue the State's licensing laws.
11. Complete the fingerprint background check process separately as instructed, and be prepared to submit the necessary documentation following your appointment.
12. Once you have completed all sections of the form, review your entries for accuracy and consistency, then proceed to save your changes, download, print, or share the completed form as required.

Start your application now and ensure you're on track to obtain your SLPA certificate!