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    OTHER ​LICENSURE FORMS

    An individual whose license has been expired for less than five years may apply for reinstatement of their license. These individual must call the Board and request a reinstatement for and inquire about the current fees for reinstatement of an expired license. Contact the Board at 410-764-4725 to request a reinstatment form.

    An individual whose license has been expired for more than five years must reapply for licensure and meet/exceed all current requirements for licensure. Use the appropriate form in the 'Licensure Forms' section and submit all required materials and fees to the Board.

    CRIMINAL HISTORY RECORDS CHECK

    LiveScan Pre-Registration Application

    In State Instructions

    Out-of-State Instructions

    Privacy Rights Act Form

    Out-of-State Fingerprint Card Requests​​


    ​​FORMS

    In accordance with the statutes and regulations in the State of Maryland, license applications can only be approved by a quorum of the Board at our monthly Board meetings. The dates of the Board meetings can be found on the landing page of our Board website: health.maryland.gov/boardsahs. Please note that the receipt of items coming from outside entities (i.e. transcripts, exam scores, verifications from ASHA, results of criminal records history checks) are not in the Board office staff’s control. Please follow-up with those entities to ensure they have sent the items requested directly to our Board. In order to determine if your license has been approved following a Board meeting, please click on the 'verify a license' link on our website 3 business days following the Board meeting. If additional information is needed to complete your application, the Board will contact you.

    Important Notice to Recent Graduates

    Recent graduates with a Master's in speech-language pathology or a Doctorate in audiology are advised that national examination score reporting by ETS is now completely electronic. Recent graduates that did not indicate the Stateof Maryland as a licensure body to receive electronic score reporting are advised to contact ETS immediately to take the necessary action required by ETS so that the Board can view an applicant's score reports. Failure to address this may result in a delay in the issuance of a license to an applicant.


    FORMS: AUDIOLOGY

    AS2-Verification of Supervision for Audiology Limited License Clinical Training ​​
    AS3-Verification of Satisfactory Completion of Audiology Clinical Training
    AS4-Affidavit To Be Completed By Licensure Board
    Audiology forms Upload

    FORMS: SPEECH-LANGUAGE PATHOLOGY

    AS2-Verification of Supervision for Speech-Language Pathology Clinical Fellowship Year
    AS3-Verification of Satisfactory Completion of Speech-Language Pathologist Clinical Fellowship Year
    AS4- Licensure Board Affidavit
    SA2-Associates in Allied Health Verifications of Minimum Coursework
    SA3- Educational Institution Verificatio​n of Completion of Required Clinical Hours
    Alternative Plan for Obtaining Required Clinical Hours​
    Verification of Completion of Required Clinical Hours ​
    Delegation Agreement
    Competency Skills Checklist
    Affidavit To Be Completed By Licensure Board
    Speech-Language Pathology forms Upload

    FORMS: HEARING AID DISPENSING

    Application For Waiver of Hearing Aid Dispenser Examination ​
    Hearing Aid Dispenser Limited License Renewal​​​
    HAD Practical Exam Schedule
    HAD Practical Exam Request​
    Hearing Aid Dispenser - Place of Business
    Hearing Aid Dispenser forms Upload

    Important Notice for Active Duty Military and Recently Discharged Military Veterans & Spouses

    Pursuant to the Veterans Full Employment Act of 2013, military veterans discharged within one (1) year of application for licensing or registration qualify for expedited processing of applications and review of equivalency requests for military training. The Board will expedite review and processing of applications of any military schools or courses submitted as qualifying equivalents for required educational licensing/registration educational standards. The Board extends these privileges to active duty military, including reservists called to active duty for training or deployment. These provisions also fully apply to spouses of active duty and qualifying veterans.

    To further comply with the letter and spirit of the Act, counseling assistance is available to qualifying veterans, active duty personnel, and spouses on application, licensing and credentialing issues. The Executive Director, Oluremi Dean, serves as the Board liaison and counselor to any qualifying veteran, active duty service member, or dependent spouse who requires information, guidance or assistance on issues relating to licensing. She may be reached via email at Oluremi.Dean@maryland.gov​ or by phone at 410-764-4723.

    This Board is prepared to assist all qualified military veterans in any way possible to meet the Act’s provisions. Should any Act provisions be further amended (or as further information becomes available) information will be posted on this website.



    CONTINUING EDUCATION​

    Individuals or organizations submitting requests for approval of Continuing Education programs or activities must submit an application (select below). Requestors should retain a copy of their application for their records. The Board will return the application noting approval or denial. Requestors should contact the Board if they have not received a response within three (3) weeks of submission. Applications may not be submitted via fax.

    Online Application for Prior Approval of a Continuing Education Program/Activity 
    Online Application for Approval of a Continuing Education Program for Individual Participation​