Sponsor's Affidavit

Please use this link to upload your sponsor's affidavit to change or remove your supervisor/sponsor as a Hearing Aid Dispenser limited licensee (HAD-LL). If you are not a HAD-LL, please locate the correct form.


Please fill out the Sponsor's Affidavit and attach it to this form. Once received, I will check for completeness and good standing. Here are the requirements for the supervisor/sponsor:

  • Shall hold a valid license issued by the Maryland Board
  • Shall be actively involved in the dispensing of hearing aids
  • Shall have been in practice for a minimum of 2 years after passing the Board examination
  • Shall supervise not more than three limited licensees at one time
  • May not have been formally disciplined by the Board within the previous 5 years.


If there are any issues or concerns, please contact either mdh.boardofahsm@maryland.gov.


Sponsor's Affidavit

The name(s) of the supervisor/sponsor(s) that will be working with the HAD-LL

The name(s) of the employment site(s) that the HAD-LL will be working at

Please upload the sponsor's affidavit

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