Temporary License: Clinical Fellowship Year

Application and Instructions for a Temporary License: Clinical Fellowship Year

Instructions:

  • FORMS: Request an official transcript from the educational institution where you received your degree be sent directly to MDH.  We will not accept a transcript from the applicant unless it is an unopened envelope.  If your degree has not been conferred we will also accept a letter from the Chair of your department, on school letterhead, stating that you have completed all the master’s or doctoral requirements to graduate and the date you have or will graduate.
  • The applicant must complete and sign part I of the application and the Waiver form.
  • The speech-language pathologist (SLP) or audiologist (AUD) who will be your supervisor must complete and sign part II of the application.
  • If you have additional supervisors, complete an application per job/supervisor and have each supervisor complete and sign page II of the temporary application.
  • Forms must be signed and dated within 30 days of submitting.
  • Make a copy of the completed form for your records.
  • Mail the original completed forms to the address on the form with a check or money order for the appropriate fee made payable to Treasurer, State of Minnesota.  (See fee schedule)
  • ALL FEES ARE NON-REFUNDABLE
  • Once MDH has received the completed application, fee and transcripts or letter from Chair of your department your money is deposited and the application will be reviewed and processed. This process takes 1- 10 business days after all documents are received. 
  • Effective August 1, 2005, all applicants for full audiologist licensing must achieve a passing score on the practical exam for hearing instrument dispensing.  Please contact Patti Fuller at 651-201-3724 for an application for the practical exam.

Any questions please call 651-201-3726 or e-mail gloria.rudolph@state.mn.us

 

FORMS:

Print application form from link: Temporary License Application Form for Clinical Fellowship and /or Doctoral Externship (pdf:38k/ 3 pages)


Link to Adobe Acrobat Reader To view the PDF files, you will need Adobe Acrobat Reader (free download from Adobe's website).

Updated Friday, 14-Oct-2011 09:06:53 CDT