1. What do I need to make certain to do?
CCCs At Last!
2. ASHA Guidelines
! Paperwork is ultimately your responsibility.
! Follow up. Follow up. Follow up.
! Who should you follow up with?
! Supervisor
! ASHA
! Send Return Receipt - trackable mail
3. ASHA Guidelines
• Getting your CF approved
! www.asha.org/certification/GettingCFApproved.htm
! CFSI - Clinical Fellow Skills Inventory - worksheet for
supervisor (link to pdf)
! Must have a 3 or above on the identified core skills in
the final segment.
! CF is no less than 36 weeks of Full-time work experience
! Supervisor held CCC during the entire CF supervision
4. ASHA Guidelines
An Application for Membership and Certification must be submitted at this time if you
have not already done so.!
!
►A separate SLPCF Report and Rating Form must be submitted for each change in
mentor, location, or regularly scheduled hours worked per week.!
!
►All blanks and boxes must be filled in. Incomplete Report & Rating forms will be returned
and will delay the processing of your application.!
!
►A full-time SLPCF consists of a minimum of 35 hours worked per week and equals
1,260 hours throughout the 36-week SLPCF. The SLPCF must consist of at least 36
mentoring activities, including 18 hours of on-site direct client contact observations and
18 other monitoring activities.!
!
►Professional experience of less than 5 hours per week cannot be used to meet the
SLPCF requirement.!
!
►Use black ink only when completing this form. Print all information clearly.!
5. Alabama State Guidelines
Completion paperwork to be submitted within
30 days of the completion of the
Supervised Professional Experience
• Licensure Fee $75
• * Mail Return receipt or Certified Mail*
• 1. Undergraduate and graduate transcripts
• 2. Results of the national examination (see below).
• 3. A notarized statement from the supervisor indicating that the
Professional Experience (CFY) has been completed.
! Number of hours per week worked
! Place of employment
! Supervisor's name
! AL license number or CCC or its equivalent.
• 4. A letter from the director of training program verifying that I
have completed the required hours of direct clinical experience
with individuals with communication
• disorders.
6. Alabama State Guidelines
Comple'on
paperwork
to
be
submi3ed
within
30
days
of
the
comple'on
of
the
Supervised
Professional
Experience
• Licensure
Fee
$75
• Common
Omissions
when
SubmiGng
the
Licensure
Applica'on
Form:
• *
A
le3er
from
the
director
of
the
educa'onal
program
verifying
that
requirements
prior
to
supervised
clinical
experience
have
been
completed.
• *
Notarized
le3er
from
CFY
or
4th
Year
Internship
Supervisor
containing:
number
of
hours
per
week
worked,
place
of
employment,
supervisor's
name
&
AL
license
number
or
CCC
or
its
equivalent.
• *
Undergraduate
and
Graduate
Transcripts.
• Another
common
misunderstanding
is
that
there
are
TWO
SEPARATE
FEES:
an
applica'on
fee
(which
is
$200),
and
a
licensure
fee
(which
is
$75).
The
applica'on
fee
is
due
with
the
applica'on.
The
licensure
fee
may
be
paid
at
that
same
'me
or
paid
once
the
applica'on
is
approved
for
licensure.
• *
Mail
Return
receipt
or
Cer'fied
Mail*
8. Florida
State Guidelines
1. Complete the Confidential and Exempt From !
Public Records Disclosure Form!
!
2. Attach a recent 2x2 color photo (above shoulders )!
!
3. Sign and date application!
!
4. $280 Fee (check/money order for application, !
licensure and unlicensed activity fees )!
!
5. Proof of 1-hour HIV/AIDS course !
(free on www.SpeechPathology.com or offered by !
any healthcare profession ) CODE: COBB13!
!
6. Proof of 2-hours prevention of medical errors course (free on !
www.SpeechPathology.com from an approved !
Board of Speech-Language Pathology!
and Audiology continuing education provider )!
!
7. SPA-2B Supervisory Evaluation for every 3 months (need 3 forms)!
!
8. SPA -2C Supervisory Report (summary)!
9. Georgia State Guidelines
All documentation must be sent to the
Georgia Licensing Board within
14 days of completion of the PCE.
• www.sos.georgia.gov
• Final Procedure once PCE is complete:
1. Fill out completion of PCE with Supervisor
2. Fill out permanent license application
3. Attach check to the top of application by examination
4. Send check made out to Georgia State Board of Speech-Language
Pathology/Audiology for $110
5. Mail Return receipt or Certified Mail.
• Completion application form:
http://sos.georgia.gov/acrobat/PLB/10%20Documentation%20for
%20Completion%20of%20Paid%20Clinical%20Experience.pdf
10. South Carolina
State Guidelines
! www.llr.state.sc.us
! Report of Completed
Internship
! Application for License
*Notarized*
! Fee $220
! Proof of Identity - Photo
ID, Driver s license
11. Maryland
State Guidelines
http://dhmh.maryland.gov/boardsahs/SitePages/Home.aspx
INSTRUCTIONS FOR APPLYING FOR A FULL LICENSE:
1.
Website above click on Professionals Licensing Information Speech-
Language Pathology License Forms Link download Speech-Language
Pathology Application For Full Licensure.
2.
Have
completed application notarized.
3.
Submit Form AS2 Verification of Supervision for Limited Licensure Clinical
Fellowship Year for each place of employment during the period of limited licensure.
4.
Submit Form AS3 Verification of Satisfactory Completion of Clinical Fellowship
Year.
5.
If you currently have or have ever been licensed in any other state, complete Form
AS4. Request the State licensure Board of that state to return the completed form to
the Maryland Board office.
6.
Submit $150.00 fee (make check or money order payable to Board of SLP).
7.
Submit a recent 2x2 passport size photo
8.
Completed Law Exam (see # 7 under Instructions For Applying For a Limited
License)
9.
Transcripts,
Undergraduate Transcript, Clinical Fellowship Year Plan (Form AS2),
Clinical Fellowship Year Verification (Form AS3), and Praxis Exam Scores.
13. Summer Thoughts...
! Organize materials
! Build Language Units
! Surf Therapy Websites to become familiar
! Build Therapy on a Dime materials
! Organize any computer files so they are easily
found during the year.
