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 kyoung@ncboeslpa.org 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.

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ASLP-IC Rulemaking comment period now open

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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