Application Instructions for a License as an Audiologist

SPECIFIC INSTRUCTIONS. You must answer every numbered question or statement in the application. If something does not apply to you, please write "N/A" in the space provided for a response. Incomplete applications will be returned. Each question in the application must be answered fully, truthfully and accurately. Intentionally submitting false or misleading information to the Commissioner is cause for denial of licensing or disciplinary action by the Commissioner. If space for any answer is insufficient, the answer may be completed on page 7 of the application. If other, additional sheets of paper are used, please specify the number of the question being answered, sign and date each page, and attach it to the rest of the application.

APPLICATIONS MUST INCLUDE THE FOLLOWING OR WILL BE CONSIDERED INCOMPLETE AND RETURNED:

  1. Documentation supporting application.
    1. Each applicant must select one of the three licensing methods and provide the documentation required for the method chosen. The methods of qualifying for licensing are: Method 1: Current ASHA or ABA certification; Method 2: Reciprocity; and Method 3: Meet all requirements for AHSA or ABA certifications, but not certified. The documentation required for each method is listed on the next page.
    2. Applicants who have held or currently hold a credential as an audiologist in Minnesota or another state must provide the documentation required in question 11.
    3. Applicants who have held or currently hold a credential to dispense hearing instruments in this or another state must provide the documentation required in question 13.
    4. Applicants for audiology licensing must take and pass the hearing instrument dispenser practical examination. Please call 651-201-3724 if you need this application.
  2. Records Waiver Authorization and Release.
  3. Check or money order made payable to the Treasurer, State of Minnesota, in the amount specified in the cover letter for your initial licensing fee. All fees are nonrefundable. Minnesota Statutes, §148.5194, Subd. 5.

Methods of Application and Instructions

METHOD 1.  (Equivalency based on Current Certifications)

You may qualify for licensing by “equivalency” under Minnesota Statutes, §148.516 if you hold a current certificate of clinical competency (CCC) issued by ASHA and/or current board certification from the American Board of Audiology. To complete your application for licensing under Method 1, you must supply documentation of your current certification(s) from ASHA or ABA or both. Acceptable documentation is a current letter of verification from ASHA and/or ABA, with original signature - copies are unacceptable. To obtain the ASHA and/or ABA letter of verification, please follow the directions below.

1. You must contact ASHA or ABA at:

ASHA
ATTN: CERTIFICATION
2200 Research Boulevard
Rockville, MD 20850-3289
Phone: 1-800-498-2071
Fax: 301-296-8580
http://www.asha.org
ABA
American Board of Audiology
11730 Plaza America Drive
Suite 300
Reston, VA 20190
Phone: 703-790-8466
Fax: 703-790-8631
http://www.americanboardofaudiology.org/

2. You must request that ASHA and/or ABA submit a letter(s) to the Minnesota Department of Health which provides the following information: your name; your ASHA and/or ABA account number; the date ASHA and/or ABA issued your certification(s); the expiration date of your current certification(s); and whether the certification(s) was issued in Speech-Language Pathology and/or Audiology. You must request that ASHA and/or ABA send the letter(s) to:

MDH/Health Occupations Program
SLPA Licensing
P.O. Box 64882
St. Paul, Minnesota 55164-0882

3. You are responsible for paying any fees requested by ASHA or ABA.

Forms needed for Method 1: Print application form from link:
License Application Information (PDF: 42.93KB / 3 pages)
SLP/A License Application Form (PDF: 56.91 KB / 7 pages)
Verification of Credential Form (PDF: 23.0 KB / 2 pages)

METHOD 2.  (Reciprocity)

You may qualify for licensing by reciprocity under Minnesota Statutes, §148.517 if you hold a current and unrestricted credential as an audiologist in another jurisdiction that has requirements equivalent to or higher than those required by Minnesota Statutes, §§148.511 through 148.5198.

PLEASE NOTE:  If you hold a current CCC and are credentialed by another state, you may apply for licensing based upon your CCC and Method 1 described above.
To complete your application for licensing by reciprocity, you must request that the appropriate person in the state in which you hold a current credential provide the information required in question 10 and a copy of the state statute and/or administrative rule which describes the qualifications for your credential at the time your credential was issued.  The letter should be sent to:

MDH/Health Occupations Program
SLP/Aud Licensing
85 E. 7th Place, P.O. Box 64882
St. Paul, Minnesota 55164-0882

You are responsible for paying any fees requested by the state or states you contact.

Forms needed for Method 2: Print application form from link:
License Application Information (PDF: 42.93KB / 3 pages)
SLP/A License Application Form (PDF: 56.91 KB / 7 pages)
Verification of Credential Form (PDF: 23.0 KB / 2 pages)

METHOD 3.  Meet all requirements for certification(s), but do not have certification)

If you do not currently hold a CCC or board certification you may qualify for licensing under Minnesota Statutes, §148.515 if you have met every requirement that ASHA and/or ABA requires for certification.  To document that you have met those requirements, you must:

  1. Contact the institution from which you received your degree. Request that the institution send directly to the Department an official transcript showing that you hold a master's or doctoral degree in speech-language pathology, audiology, or communication disorders. The Department will not accept a transcript from the applicant unless it is in a registrar's official, sealed and unopened envelope.

  2. Contact the institution where you completed your supervised clinical training. Supervised clinical training is completed while one is a student. Have the appropriate person(s) at the institution sign and date Form A.

  3. Contact the organization where you completed your supervised post-graduate clinical fellowship or doctoral internship experience. Supervised post-graduate clinical experience is completed after graduation. Have the appropriate person at the organization sign and date Form B.

  4. Provide a copy of your score report showing a passing score on the National Examination in Speech-Language Pathology or Audiology (NESPA).
Forms needed for Method 3:  Print application form from link:
License Application Information (pdf:38k / 3 pages)
SLP/A License Application Form (pdf:57k/ 7 pages)
Verification of Credential Form (pdf:23k/ 2 pages)
Audiologist Licensing - Form A (pdf:16k/ 1 page)
Audiologist Licensing - Form B (pdf:18k/ 1 page)

If you have any questions please call 651-201-3726 or e-mail gloria.rudolph@state.mn.us

Updated Thursday, 13-Oct-2011 15:20:42 CDT