SPEECH-LANGUAGE PATHOLOGY & AUDIOLOGY & HEARING AID DISPENSERS BOARD - REQUEST FOR LICENSE VERIFICAT 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling in your personal information under 'LICENSEE INFORMATION'. Ensure you provide the name exactly as it appears on your license, especially if it differs from your current name.
3. Select your 'LICENSE TYPE' by checking the appropriate box for either HAD or DAU.
4. Enter your 'LICENSE NUMBER', 'LICENSE ISSUE DATE', and 'EXPIRATION DATE' accurately to avoid processing delays.
5. Provide a contact number in the 'TELEPHONE NO.' field, including the area code for better communication.
6. Fill out the address of the agency where the verification should be sent. Include all relevant details such as business name, attention line, street address, city, state, and ZIP code.
7. Finally, sign and date the form at the bottom to confirm that all information is true and correct. This step is crucial for processing your request.

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