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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
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.
You may also request an application by writing at:
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:
INSTRUCTIONS AND INFORMATION
Indiana Professional Licensing Agency
Attn: SLPA Board
402 West Washington Street, Room W072
Indianapolis, Indiana 46204
THE FAIR INFORMATION PRACTICE ACT
MANDATORY DISCLOSURE OF U.S. SOCIAL SECURITY NUMBER
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.
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.
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.
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.