Department (Required) Tech Support Other Complaints Assistants Reciprocal Applications Verifications Renewals Continuing Education Incorporations Supervision of Temporary Licensees Initial Audiology SEY Plans/Reports Statute & Rules Mailing Lists Wall Certificates Expired Licenses Accessibility Issues Feedback Department Choice (Required)
To receive the quickest response possible I understand that if I choose the incorrect department for my query I assume full responsibility for a delayed response.
To view the list of what each office staff member handles please view the staff page located under “Board Information”, then from the dropdown menu click, “Staff”. The Board Staff page can be
This form option is for anyone experiencing barriers in navigating or accessing areas of our website, PDF files, our new system, etcetera.
This is also where you can request documents in different formats. For this please specify document name (e.g. Article 22) and the format you need it in (e.g. braille, large font) in the message box below. If you are experiencing technical difficulties please use the “Tech Support” option from the “Department” dropdown selection list. Accessibility Issues Feedback (Required)
By filling out this form I understand that this form submission is going to provide feedback and help the Board make improvements so all aspects of our website and system are accessible to everyone.
I understand Mailing List Request (Required)
I understand that by filling out this form that I am submitting an inquiry and not a mailing list request form.
I understand that mailing list request forms are $50 for check and money order payments, and online payments have a convenience charge applied. I understand Mailing List request forms and payment can be submitted through the online form available here. Verification Request (Required)
I understand that by filling out this form that I am submitting an inquiry and not an official letter of verification request form.
I understand that official letter of verification request forms are $15 for check and money order payments, and online payments have a convenience charge applied. I understand Official Letter of Verification forms can be submitted through the licensee portal, for active licensees only or through here. Name (Required)
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