Audiologist Limited License Application

To expedite the application process, please upload electronic copies of your application and all supporting documents. The Original application must be notarized and official transcripts and verifications must be mailed to the Board within 30 days of issuance of licensure. For application status updates or questions about the application process please email mdh.boardofahsm@maryland.gov

Use the link the below to print and complete an application. The application must be notarized prior to uploading a copy. The application fee can be paid via credit card using the link below. Please upload a copy of the receipt once paid. Please make sure to either take a screenshot of the receipt on your screen or download it as a pdf, please also check your email for a copy.

AUD Limited Application

AUD Limited Application Fee

Note to Applicants: Applicants who submitted their applications online will be sent a link to complete the required law exam electronically. If you are unable to submit your application online, you may print a paper version from our website. Please use the statute and regulations under the Regulations tab to complete the Law Exam. A completed Law Exam must be on file for an application to be considered complete.

Frequently Asked Questions

Name*

Email*

Phone Number*

Street Address (number, street, apt #)*

City, State, Zip Code*

Implicit Bias Training*

Check this box only if you have completed an approved Implicit Bias Course. If you are not sure, please use the link provided.

https://health.maryland.gov/boardsahs/Documents/Implicit%20bias%20updated%20training.pdf

Proposed Supervisor*

Supervisor(s) of limited licensee during limited licensure.

All proposed supervisors will be checked to ensure they're in good standing. Any supervisors not in good standing will not be approved.

Proposed Employment site*

The site(s) where the limited licensee will be practicing.

Upload Application/Supporting Documents*

Application ( PDF's ONLY. Upload the application as one file. DO NOT Submit each page separately), Copy of Check/Payment, AS3, Resume, Transcript, ASHA

Drag and drop files here or

Copy of Application & NOTARIZED Photo*

Check once a copy of your application & a copy a NOTARIZED photo has been uploaded in field above.

Payment*

Please make a payment using the link below. Once complete please upload a copy of your receipt and check the box below. AUD Limited Application Fee

Submit Payment

Payment Receipt Transaction Number*

Please provide the transaction number from your payment receipt before you upload it.

Background Check Privacy Rights Form*

Check once a copy of the signed Background Check Privacy Rights Form has been uploaded above. In State sign the last page of the document below.

In State Form

Out-of-State sign the last page of the document below.

Out-of-State Form

Out-of-State Fingerprint Card Request

Background Check*

Instructions can be found using the link below.

Background Check Instructions

Select or enter value

Copy of official transcript*

Check once a copy of your official transcript has been uploaded in the field above.

Copy of AS2

Check once a copy of your AS2 has been uploaded in the field above.

Copy of AS3

Check once a copy of your AS3 has been uploaded in the field above.

Send me a copy of my responses

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