Forms / Applications

 APPLICATIONS

   F1-ARA            APPRENTICE REGISTRATION APPLICATION

   see F1            PLAN OF SUPERVISION (now part of F1 application)

   F3-RAE            REPORT OF APPRENTICESHIP EXPERIENCE

   F4-ALER          APPLICATON FOR LICENSE / EXAM REGISTRATION

   F8-RSA            REGISTERED SPONSOR APPLICATION

   use F1          RENEW or REPLACE APPRENTICE CERTIFICATE APPLICATION

   F17-ALR   2017 ANNUAL LICENSE RENEWAL APPLICATION
(available Feb 1, 2017)

   F10   APPLICATION FOR LICENSE / EXAM REGISTRATION
(for military applicants only)

   LME         HEARING AID SPECIALIST LICENSURE BY MILITARY ENDORSEMENT

  AFFIDAVITS

   F1-ARA            APPRENTICE REGISTRATION AFFIDAVIT

   F3-RAE            REPORT OF APPRENTICESHIP EXPERIENCE AFFIDAVIT

   F4-ALER          APPLICATON FOR LICENSE / EXAM REGISTRATION AFFIDAVIT

   F5-OWAR        OTOLARYNGOLOGIST AFFIDAVIT (Waiver of Apprenticeship)

   F6-LWAR         LICENSED OUT OF STATE AFFIDAVIT (Waiver of Apprenticeship)

   F7-VOL           VERIFICATION OF LICENSE form

   F8-RSA            REGISTERED SPONSOR AFFIDAVIT

   use F1          RENEW or REPLACE APPRENTICE CERTIFICATE AFFIDAVIT

  FORMS

   BGC               BACKGROUND CHECK (USE PACKAGE CODE "NC16")

   CAP               COMPLAINT AGAINST PROVIDER (to Committee on Investigations)

   CE                  CONTINUING EDUCATION (forms, reports, applications)

   EPR                ELECTRONIC PAYMENT REQUEST (invoice to pay fees online)

   LOG               LOG OF SUPERVISION

   RAC                REGISTER as AUTHORIZED CALIBRATER

   RER                REQUEST EXAM REVIEW (submit within 20 days of Notice of Results)

   RLQ                RELINQUISH LICENSE (Au.D. exempt from licensure)

   F11                ADDRESS CHANGE

   F7-VOL           VERIFICATION OF LICENSE form