Health Occupations Program
Licensing Program for
Audiologists and Speech-Language Pathologists
Examination Application Forms
Hearing Instrument Dispenser Examination applications are accepted on a first-come first-served basis. We will accept applications until the exam application deadline or until we have received 25 complete applications. Applications will not be considered complete until the completed Hearing Instrument Dispenser Examination application and required fee are received by our office.
Please print all twelve forms and documents listed below.- Hearing Instrument Dispenser Examination Memo (pdf: 35k/ 3 pages)
- Hearing Instrument Dispenser Examination application (pdf: 32k/ 4 pages)
- Hearing Instrument Dispenser Examination overview (pdf: 27k/ 3 pages)
- Bibliography (pdf: 24k/ 4 pages)
- Sample Informed Consent Agreement-For your subject's review (pdf: 23k/ 1 page)
- Minnesota Statute Section 148.5197 Hearing Aid Dispensing
- Minnesota Statute Section 148.5198 Restriction on Sale of Hearing Aid (1 page)
- Minnesota Statute Chapter 153A - Hearing Instrument Dispenser Certification
- Minnesota Statute Section 325G.06-325G.14 Home Solicitation Sales (pdf: 6 pages)
- Minnesota Statute Section 325G - 325G.203 - 325G Assistive Device (pdf: 5 pages)
- FDA Part 801. Subpart H Special Requirements for Specific Devices
Section 801.420 Hearing Aid devices; professional and patient labeling (5 pages)
- FDA Part 801. Subpart H Special Requirements for Specific Devices
Section 801.421 Hearing aid devices; conditions for sale (2 pages)
Once you have printed all twelve forms and documents please complete the Hearing Instrument Dispenser Examination application and mail with the required fee to the address listed at the top of the hearing Instrument Dispenser Examination application.
If you are unable to print the examination application and forms please contact Patti Fuller 651-201-3724 or Patti.Fuller@state.mn.us
