This may only be completed by the Board approved supervising Audiologist, this form may not be completed by another Audiologist, the Audiology Assistant, or Office Staff.

The primary supervising audiologist will complete this competency and orientation document during the first sixty (60) days of employment and forward the signed, original copy to the Board of Examiner’s (the Board) office within 30 days of completion. A new competency assessment and orientation must be completed whenever the licensee who registers the assistant changes.