Speech-Language Pathologists Limited License Application

Please upload electronic copies of your application and all supporting documents. For application status updates or questions about the application process please email mdh.boardofahsm@maryland.gov

Use the link below to complete an SLP Limited application. Please be sure to include either a physical wet signature or an e-signature. Applications without a signature will be considered incomplete. Please upload your signed application and supporting documents in the attachment field box.

Please make sure to put hours in all columns of the AS2 and include the totals, only numbers are acceptable, words are NOT acceptable.

Column 1 (Left) - Hours spent per week by the applicant, at least 80% of the hours must be in rows 1-3
Column 2 (Middle) - Hours spent per month by the supervisor
Column 3 (Right) - Other monitoring activities, at least 2 hours required

All supervisors will be checked for good standing, these are the requirements:

Hold a current Full License in Speech-Language Pathology (or, if the position is in a setting where licensure is not required, the supervisor shall hold a current CCC-SLP from ASHA.)
Have been in practice for a minimum of 2 years after completion of the clinical fellowship
Supervise not more than three limited licensees at one time.
Not have been formally disciplined by the Board within the previous 5 years.

Speech-Language Pathologists Limited License Application

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.

SLP Limited Application Fee

Applicants will be sent a link to complete the required law exam electronically. Please use the statute and regulations links 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, AS2, Transcript

Drag and drop files here or

Copy of Application & Photo*

Check once a copy of your application & a passport sized 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. SLP 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.

Privacy Rights Act Form

Background Check*

Instructions can be found using the link below.

Background Check Instructions

Out-of-State Fingerprint Card Request

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.

Send me a copy of my responses

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