Hearing Aid Dispensers 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 the below to complete a HAD 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.

HAD 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.

HAD 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*

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 Payment, Transcript, HA2, HA3, Privacy Rights Act Form

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 recent and check the box below. HAD Limited Application Fee

Submit Payment

Payment Transaction*

Please enter the Transaction number from your receipt before you upload your receipt.

Background Check*

Instructions can be found using the link below.

Privacy Rights Act Form

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 Sponsor Affidavit*

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

Send me a copy of my responses

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