SLP-Assistant Application

Please note: SLP-Assistants in North Carolina are only authorized to serve the caseload of their Primary Supervisor(s). SLP-Assistants are registered under an actively licensed Speech-Language Pathologist in North Carolina. The Primary Supervisor is fully responsible for the SLP-Assistant, not the employer. The Primary or Secondary Supervisor must be within 50 miles of the SLP-Assistant during the time that the SLP-Assistant is providing services.
Assistant Information
Name*
Prefix First Middle Last
Other names you have used
Include maiden name; add as many as apply.
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
This number is:
- Home
- Cell
Phone (other)
Email
Social Security Number or Individual Tax ID Number*
Date of Birth*
MM slash DD slash YYYY
Exam Choice*
If you change your mind after this submission, you will need to notify the Board office.
- I have taken the NC SLP-Assistant Exam
- I will be taking the NC SLP-Assistant Exam
- I have taken the ASHA SLP-Assistant Exam
- I will be taking the ASHA SLP-Assistant Exam
Education
List each degree adding as many rows as necessary*
Institution Name City/State Major Field of Study Type of Degree Received Date Conferred

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General Information
The statute requires that you either hold an Associate's Degree in SLP-Assisting or that you have a Bachelor's Degree in Speech and Language plus Assisting courses or coursework deemed equivalent by the Board of Examiners. Please submit your official transcript(s) to [email protected] or have them mailed to the Board's office.
21 CAC 64 .1002 GENERAL REQUIREMENTS
(1) For registration, Assistants must present:
- evidence of successful completion of an Associate's Degree in Speech-Language Pathology Assisting from an accredited institution of higher learning, community college, or equivalent program. Official transcripts may be emailed directly from the training program to the Board to [email protected] ; OR
- evidence of successful completion of a Bachelor's Degree from an accredited institution as well as a passing score on the N.C. SLP-Assistant Jurisprudence Exam. Official transcripts may be emailed directly from the training program to the Board to [email protected]
(2) a passing score on a competency test approved by the Board.

(3) The SLP-Assistant Registration documents completed and signed by the SLP-Assistant and supervising licensee(s). This packet includes all of the following:
- Applicant Information form
- Knowledge Demonstration for Licensed Speech-Language Pathologists to register a SLP-Assistant.
- SLP-Assistant Protocol Target Behavior Form- filled out and signed by both the SLP-Assistant and supervising licensee.
- Official transcripts with degree(s) conferred (Must be Printable if sent by official School email).
- Official letter(s) of verification from 'other states (if applicable).
- SLP-Assistant Registration fee $40.00*
*If payment is made by personal or business check, it must clear the mandatory 10-day hold from day of deposit before documents will be mailed out. Deposits are typically made on Fridays. These fees may also be paid by money order, cashier's check/bank check, or on our website through Pay Pal.
Do you have experience in another state as an SLP-Assistant?*
If you have been registered or license as a Speech-Language Pathology Assistant in another state, you will need to provide a letter of verification from the state where you have most recently provided services. This letter of verification must come directly from the other state board's office to the NC board's office. They may be sent electronically to [email protected]
- Yes
- No
Email print version of completed form
Would you like a PDF version of this completed form emailed to you?*
- Yes
- No
Email (for PDF delivery)*
Please enter an email address to receive a copy of this completed form.
Transcript Submission*
- I have requested my Official Transcripts be mailed to the Board's PO Box
- I have requested my Official Transcripts be emailed to [email protected]
Have you submitted an Application to be an SLP-Assistant in the past?*
- Yes
- No
By signing I understand that I may not obtain clinical fieldwork hours/provide services as a SLP Assistant until my supervising SLP and I have completed the application and registration process for a temporary registration/registration and I receive my temporary registration/ registration number and official notification from the Board that my registration has been issued. Completing clinical fieldwork hours/ providing services as and SLP Assistant without properly registering with the Board violates NC 901-301 A .(2) and may be subject to discipline.*
I understand that I may not obtain clinical fieldwork hours/provide services as a SLP Assistant until my supervising SLP and I have completed the application and registration process for a temporary registration/registration and I receive my temporary registration/ registration number and official notification from the Board that my registration has been issued. Completing clinical fieldwork hours/ providing services as and SLP Assistant without properly registering with the Board violates NC 901-301 A .(2) and may be subject to discipline.

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Guidance for OTC Hearing Aids View Resources

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Assistant Information

Education

General Information

21 CAC 64 .1002 GENERAL REQUIREMENTS

Email print version of completed form

Apply

Institution Name	City/State	Major Field of Study	Type of Degree Received	Date Conferred