Forms

Chapter 4747

Individual License Renewal Update for Hearing Aid Trainee or Hearing Aid Dealer Business Location

Individual licensees will need to download, complete and then upload the completed form. Download Renewal Update form.

NOTE This is a one-time requirement when renewing with eLicense.Ohio.gov.

Hearing Aid Trainee Permit Notary Form

When applying for your Trainee Permit, you will need to download, complete and return to the Board the Trainee Permit Notary Form. Download Trainee Permit Notary Form.

The form needs to be completely filled out and you and your supervisor need to sign the completed form in front of a notary public.

Hearing Aid Trainee Supervision Report and Hearing Aid Trainee Supervision Log

Upon completion of your hearing aid fitter trainee supervision or when there is a change in the hearing aid fitter trainee supervision plan, the 5-page Trainee Supervision Report and Trainee Supervision Log must be submitted to the Board within 30 calendar days.

Both forms are in Microsoft® Word format and are contained in one download. Download Report and Supervision Log.

Both forms need to be completed, and you and your supervisor need to sign the Hearing Aid Trainee Supervision Log.

Chapter 4753

Application for Speech-Language Pathology Aide or Audiology Aide Aide Plans may no longer be mailed to the Board. Your Aide Plan must be downloaded, completed and uploaded to eLicense.Ohio.gov.

Conditional License for Professional Experience Options (CFY) Currently off-line

Forms Required for Professional Experience

All forms for professional experience must be submitted using eLicense.Ohio.gov. Step-by-step instructions are contained on the first page of each form; e.g. Plan, Amended Plan, and Report and Log.

Supervised Professional Experience Plan Submit within 30 days of beginning the experience

Amended Supervised Professional Experience Plan Submit within 30 days of a change; e.g. end date, supervisor, full-time/part-time

Supervised Professional Experience Report and Supervision Contacts Log Submit within 30 days of completion

Supervised Professional Experience Report and Supervision Contacts Log Submit within 30 days of completion Note Download the Microsoft® Word version if you would like the option to type your entries on the Report and Log

Supervised Professional Experience—Clinical Outcomes

Plan Calculator Currently off-line

Avoiding Common Mistakes During the Professional Experience Year (PEY)

eLicense Application Status FAQ

Supervised Professional Experience Guidelines

Information for applicants graduating from programs outside of Ohio

Sample University Verification Letter For Expedited Licensure

Sample University Verification Letter For Expedited Licensure

Page updated 01/22/2018