REGULATIONS
Vol. 39 Iss. 19 - May 08, 2023

TITLE 18. PROFESSIONAL AND OCCUPATIONAL LICENSING
BOARD OF AUDIOLOGY AND SPEECH-LANGUAGE PATHOLOGY
Chapter 21
Forms

REGISTRAR'S NOTICE: Forms used in administering the regulation have been filed by the agency. The forms are not being published; however, online users of this issue of the Virginia Register of Regulations may click on the name of a form with a hyperlink to access it. The forms are also available from the agency contact or may be viewed at the Office of the Registrar of Regulations, 900 East Main Street, 11th Floor, Richmond, Virginia 23219.

Title of Regulation: 18VAC30-21. Regulations Governing Audiology and Speech-Language Pathology.

Agency Contact: Erin Barrett, Regulatory Coordinator, Department of Health Professions, 9960 Mayland Drive, Suite 300, Henrico, VA 23233, telephone (804) 367-4688, or email erin.barrett@dhp.virginia.gov.

FORMS (18VAC30-21)

Instructions/Checklist for Completing an Application to Practice as an Audiologist in Virginia (Includes Provisional for Re-entry Into Practice) (rev. 6/2020)

Instructions/Checklist for Application for Provisional License to Practice as an Audiologist in Virginia (New Graduates Only) (rev. 6/2020)

Instructions/Checklist for Completing an Application to Practice as a School Speech-Language Pathologist in Virginia (rev. 6/2020)

Instructions/Checklist for Reinstatement of an Expired License (rev. 6/2020)

Instructions/Checklist for Reactivating a Current Inactive License (rev. 6/2020)

Instructions/Checklist for Completing an Application to Practice as an Audiologist (Includes Provisional for Re-Entry into Practice) (rev. 3/2023)

Instructions/Checklist for Application for Provisional License to Practice as an Audiologist (New Graduates Only) (rev. 3/2023)

Instructions/Checklist for Completing an Application to Practice as a Speech-Language Pathologist (Includes Provisional for Re-Entry into Practice) (rev. 3/2023)

Instructions/Checklist for Completing an Application to Practice as a School Speech-Language Pathologist (rev. 3/2023)

Instructions/Checklist for Reinstatement of an Expired License (rev. 3/2023)

Instructions/Checklist for Reactivation of a Current Inactive License (rev. 3/2023)

Request for Verification of Out-of-State License (rev. 6/2020)

Employment Verification (rev. 6/2020)

Continuing Education Reporting Form (rev. 6/2020)

Continuing Education (CE) Credit Form for Volunteer Practice (rev. 6/2020)

Request for Verification of a Virginia License (rev. 6/2020)

Name/Address Change Form (rev. 6/2020)

Sponsor Certification for Volunteer Registration (rev. 6/2020)

Application for Registration to Volunteer Practice (rev. 6/2020)

VA.R. Doc. No. R23-7541; Filed April 14, 2023