Get Audiology Application For Full Licensure - Dhmh Maryland

This guide provides a step-by-step approach for completing the audiology application for full licensure in Maryland. It outlines essential information needed for a successful submission, ensuring that all users can navigate the process with confidence.

Follow the steps to fill out the application effectively.

1. Click ‘Get Form’ button to obtain the form and open it in the editor, allowing you to start filling out your application easily.
2. Begin by entering your personal information, including your name, date of birth, and social security number. Ensure all details are accurate and double-check for typographical errors.
3. Upload your recent passport-sized photo in the designated area on the application form.
4. Fill in your residential address and provide a valid contact number, along with an alternate telephone number and email address.
5. Provide your professional address, specifying the facility or company’s name where you will be employed as well as the corresponding address and contact details.
6. Indicate if you have previously been licensed in Maryland, along with the license number and expiration date if applicable.
7. Disclose any felony or misdemeanor convictions related to moral turpitude if applicable. If yes, attach full details as required.
8. Complete the education and employment section, listing your educational background, including names and locations of institutions attended, dates, and degrees obtained.
9. Answer questions regarding your certifications, including those from the American Board of Audiology or the American Speech-Language-Hearing Association.
10. Provide detailed descriptions of your clinical training and supervision, ensuring to submit verification forms as needed.
11. After completing the application, review all sections for accuracy before submitting.
12. Finally, users can save changes, download, print, or share the completed application form.

Begin filling out your application online to get closer to your audiology licensure.