Please use this form to request a limited licensee be removed from your supervision. Please provide the name of the licensee to be removed, your information, and a statement detailing the reason for removal.

Upload a signed letter in pdf format for the reason for removal and upload it using the file upload option below.

Note: All limited licensees need to have at least one supervisor. They should complete the AS2 (for limited SLPs) or the SA6 (for limited SLPAs) if they wish to continue their limited licensure.

AS2

SA6