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Click ‘Get Form’ to open the ND State Audiology and Speech Language Pathology License Renewal Application in the editor.
Begin by entering your LICENSE NUMBER and selecting the appropriate LICENSE type (AUD, SLP, or SLPLA).
Fill in your NAME, PREVIOUS LAST NAME, and ADDRESS details. Ensure accuracy as this information is crucial for processing.
Indicate if you have a NEW ADDRESS since January 1, 2019 by checking 'Y' or 'N'.
Provide your HOME PHONE and BUSINESS PHONE numbers for contact purposes.
List your PRESENT EMPLOYMENT details including address and zip code.
Complete the CONTINUING EDUCATION EXPERIENCE section by attaching proof of attendance for each seminar attended. Fill in the DATE, PLACE, TITLE OF SEMINAR, PRESENTER, and NUMBER OF HOURS for each entry.
Sign the AFFIDAVIT confirming that all information provided is true. Include the date of signing.
Review your application to ensure all sections are completed before mailing it to NDSBE at the specified address.
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