- Documentation evidencing completion of a high school education or its equivalent
- A supervisory plan/activity plan form
Applicants with Discipline History
Applicants with prior disciplinary actions are required to submit the following documentation WITH the application at the time of submission:
- A self-explanation including details as to the state(s), license number(s), date(s), and relevant circumstances.
- A copy of the complaint and disposition for each case.
- A copy of any documentation from the state regarding the final actions/outcome of the issue.
Applicants with Health History
If you answer “yes” to any of the health history questions on the application, please submit supporting documentation including:
- A self-explanation providing accurate details (including, but not limited to, the date(s), location(s), specific circumstances, practitioners and/or treatment involved).
- If you have been under treatment for emotional/mental illness, chemical dependency, etc., you must request that each practitioner, hospital, and program involved in your treatment submit a full, detailed report of such to the board office, to include: treatment received, medications, and dates of treatment and, if applicable, all DSM III R/DSM IV/DSM IV-TR Axis I and II diagnosis (es) code(s), and admission and discharge summary(s).
Applicants with Criminal History
Applicants with prior criminal convictions are required to submit the following:
Final Dispositions/Arrest Records – Final disposition records for offenses can be obtained at the clerk of the court in the arresting jurisdiction. If the records are not available, you must have a letter on court letterhead sent from the clerk of the court attesting to their unavailability.
Completion of Probation/Parole/Sanctions – Probation and financial sanction records for offenses can be obtained at the clerk of the court in the arresting jurisdiction. Parole records for offenses can be obtained from the Department of Corrections or at the clerk of the court in the arresting jurisdiction. If the records are not available, you must have a letter on court letterhead sent from the clerk of the court attesting to their unavailability.
Self-Explanation – Applicants who have listed offenses on the application must submit a letter in their own words describing the circumstances of the offense. Include in your letter the date of the original offense, the charge, and the jurisdiction where it occurred.
Health Care Fraud; Disqualifications for License, Certificate, or Registration
Effective July 1, 2012, Section 456.0635, Florida Statutes (F.S.), provides that health care boards or the department shall refuse to issue a license, certificate or registration and shall refuse to admit a candidate for examination if the applicant:
- Has been convicted of, or entered a plea of guilty or nolo contendere to, regardless of adjudication, a felony under Chapter 409, F.S., (relating to social and economic assistance), Chapter 817, F.S., (relating to fraudulent practices), Chapter 893, F.S., (relating to drug abuse prevention and control) or a similar felony offense(s) in another state or jurisdiction unless the candidate or applicant has successfully completed a drug court program for that felony and provides proof that the plea has been withdrawn or the charges have been dismissed. Any such conviction or plea shall exclude the applicant or candidate from licensure, examination, certification, or registration, unless the sentence and any subsequent period of probation for such conviction or plea ended:
- For the felonies of the first or second degree, more than 15 years from the date of the plea, sentence and completion of any subsequent probation;
- For the felonies of the third degree, more than 10 years from the date of the plea, sentence and completion of any subsequent probation;
- For the felonies of the third degree under section 893.13(6)(a), F.S., more than five years from the date of the plea, sentence and completion of any subsequent probation;
- Has been convicted of, or entered a plea of guilty or nolo contendere to, regardless of adjudication, a felony under 21 U.S.C. ss. 801-970 (relating to controlled substances) or 42 U.S.C. ss. 1395-1396 (relating to public health, welfare, Medicare and Medicaid issues), unless the sentence and any subsequent period of probation for such conviction or pleas ended more than 15 years prior to the date of the application;
- Has been terminated for cause from the Florida Medicaid program pursuant to section 409.913, F.S., unless the candidate or applicant has been in good standing with the Florida Medicaid program for the most recent five years;
- Has been terminated for cause, pursuant to the appeals procedures established by the state or Federal Government, from any other state Medicaid program, unless the candidate or applicant has been in good standing with a state Medicaid program for the most recent five years and the termination occurred at least 20 years before the date of the application;
- Is currently listed on the United States Department of Health and Human Services Office of Inspector General’s List of Excluded Individuals and Entities. The section above does not apply to candidates or applicants for initial licensure or certification who were enrolled in an educational or training program on or before July 1, 2009, which was recognized by a board or, if there is no board, recognized by the department, and who applied for licensure after July 1, 2012.
- Applicant must submit application with the appropriate fees to the board office.
- All supporting documentation that is submitted will be reviewed to determine compliance with current requirements. If additional documentation is required to complete the application, a deficiency letter will be sent.
- Once the application has been deemed complete, a license is issued within 4-7 working days.
* * Please Note: Some applicants may require a board appearance prior to licensure based on previous disciplinary action, criminal history, health history, educational criteria or other reasons as deemed necessary. In the event that your application will have to be presented to the board, you will be notified in advance.
Make cashiers checks or money orders payable to the “Department of Health.” Applicants applying online may use a major credit card or debit card.
|TOTAL FEE||$130.00 (includes a $75.00 non-refundable application processing fee)|
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Florida Administrative Code (F.A.C.)
Rules: Chapter 64B20: Board of Speech-Language Pathology and Audiology