Temporary License: Renewal

You can renew a temporary license twice.
You will need to start this process 30 days before your temporary license expires.

This application may be used for renewal of a Temporary License for Clinical Fellowship/Doctoral Externship or Persons Credentialed by ASHA, ABA or Other States

INSTRUCTIONS:

  • The applicant must complete and sign Part I of the Application and the Waiver and Release form.
  • The speech-language pathologist or audiologist that will be your supervisor must complete and sign Part II of the application form.
  • Make a copy of the completed forms for your records.
  • ALL FEES ARE NON-REFUNDABLE
  • Mail the original completed forms to the address on the form with a check or money order for the appropriate fee (see fee schedule) made payable to Treasurer, State of Minnesota.
  • Once MDH has received the completed application and fee your money is deposited and the application will be reviewed and processed.  This process takes 1-10 business days.  Your approval letter and wallet card will be mailed to the designated address listed on your application.
  • Any questions please call 651-201-3726 or email gloria.rudolph@state.mn.us

FORMS:

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

Print application form from link:  Temporary License Application Form for Persons Credentialed by ASHA, ABA, or other States (PDF:33k/ 2 pages)

Updated Friday, October 14, 2011 at 09:09AM