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Indiana Professional Licensing Agency

PLA > Professions > Speech-Language Pathology Audiology Board > Application and Instructions - Speech-Language Pathology Aide Registration Application and Instructions - Speech-Language Pathology Aide Registration

Registration Application and Instructions

Application for Registration as a Speech-Language Pathology AideI or Aide II

You can download the application now by clicking on the link above. *To view a PDF file you will need the free Adobe Acrobat Reader

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If you do not have adobe acrobat, or if you would prefer to receive an application packet by mail, you may obtain one by calling our automated attendant at (317) 232-2960 or by contacting the Board at (317) 234-2064.

PLEASE NOTE: SEND ALL CORRESPONDENCE TO NEW ADDRESS LISTED BELOW!

You may also request an application by writing at:

Professional Licensing Agency
(Attn: Speech-Language Pathology and Audiology Board)
402 West Washington Street, Room W072
Indianapolis, Indiana 46204

or email us at pla5@pla.IN.gov. Please specify that you are requesting a Speech-Language Pathology Aide Registration application and provide your name and full mailing address.

SPEECH-LANGUAGE PATHOLOGY AND AUDIOLOGY BOARD

SPEECH-LANGUAGE PATHOLOGY AIDE I OR AIDE II REGISTRATION APPLICATION PACKET

This application packet should contain the following information:

  1. Two (2) pages of instructions and information
  2. A four (4) page application form
  3. One copy of the Statute (IC 25-35)
  4. One compilation of the Licensing Statute (IC § 25-35) and the Rules and Regulations (Title 880)
If your application packet does not contain these items, please contact the Indiana Professional Licensing Agency at (317) 234-2064 or by email at pla5@pla.in.gov.

INSTRUCTIONS AND INFORMATION

Before completing and submitting your application to the Indiana Professional Licensing Agency, please read all materials and information included with this packet. If you have any questions, please contact the Health Professions Bureau at (317) 234-2064 or by email at pla5@pla.in.gov. For additional information, please visit our website at http://www.pla.in.gov/.

AGENCY ADDRESS
Indiana Professional Licensing Agency
Attn: SLPA Board
402 West Washington Street, Room W072
Indianapolis, Indiana 46204

THE FAIR INFORMATION PRACTICE ACT

In compliance with IC § 4-1-6, this agency is notifying you that you must provide the requested information or your application will not be processed. You have the right to challenge, correct, or explain information maintained by this agency. The information you provide will become public record. Your examination scores and grade transcripts are confidential except in circumstances where their release is required by law, in which case you will be notified.

MANDATORY DISCLOSURE OF U.S. SOCIAL SECURITY NUMBER

Pursuant to Section 7 of the Privacy Act of 1974, you are hereby given notice that disclosure of your U.S. Social Security number on this application is mandatory for the purpose of complying with IC § 25-1-5-8 and IC § 4-1-8-1 which provide that the Indiana Department of Revenue may obtain Social Security numbers from the Indiana Professional Licensing Agency for tax enforcement purposes. In addition, disclosing such number is mandatory in order for the Speech-Language Pathology and Audiology Board to comply with the requirements of the federal National Practitioner Data Bank and the Healthcare Integrity and Protection Data Bank 42 U.S.C. §1320(a)-7e(b), 5 USC §552a, 45 CFR Part 60.1, and 45 CFR Part 61.

Failure to disclose your U.S. social security number will result in the denial of your application. Application fees are not refundable.

APPLICATION FOR REGISTRATION AS A SPEECH-LANGUAGE PATHOLOGY AIDE I OR AIDE II

Please note that the registration of SLP aides has recently changed to a two-tiered system, based on level of education. It is imperative that the licensed speech-language pathologist, who will be supervising the aide, is familiar with the new requirements regarding supervision of these two different types of aides.

APPLICATION
Mail completed application along with all required documentation listed below to the Indiana Professional Licensing Agency:

    AIDE I OR AIDE II
    Complete and sign the portion of the application marked, "This section to be completed by the Speech-Language Pathology Aide" (Pages 1-2). Answer all questions on the application. If additional space is needed, please attach on a separate sheet of paper.

    AIDE SUPERVISOR
    Complete and sign the portion of the application marked, "This section to be completed by the Supervisor" (Pages 3-4). Answer all questions on the application. If additional space is needed, please attach on a separate sheet of paper.

APPLICATION FEES
Applicants must submit a fifty dollar ($50) application/issuance fee, made payable to the Indiana Professional Licensing Agency. This fee may be submitted by cash, check or money order. We cannot accept payment by credit card. ALL FEES ARE NON-REFUNDABLE AND NON-TRANSFERABLE.

Licensure verifcation for other states - $10.00 fee.

SUPERVISOR'S CURRENT LICENSE
In order to supervise a speech-language pathology aide I or aide II, the supervisor must hold a current Indiana license as a speech-language pathologist issued by the Speech-Language Pathology and Audiology Board.

CHANGE OF SUPERVISOR
If you are no longer being supervised by the speech-language pathologist listed on your application, a new application must be filed. In order to obtain a new application please call the Indiana Professional Licensing Agency and request a Speech-Language Pathology Aide I or Aide II. Application and the application will be forwarded to you. After your new application and fee are received and approved, you will receive a new registration number.

RENEWAL OF REGISTRATION/CHANGE OF ADDRESS
All Aide registrations expire on December 31st of each year. A renewal form will be sent to all registrant’s sixty (60) days prior to the expiration. Please make sure your address is current at all times with the Indiana Professional Licensing Agency. If you need to report a new address, please put the change of address in writing with your registration number and send it to the Indiana Professional Licensing Agency.