Audiologist Assistant License Application

Audiologist Assistant 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 an AUD Assistant 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.

AUD Assistant Application

The application fee can be paid via credit card using the link below. Please upload a copy of the receipt once paid.

AUD Assistant Application Fee

Applicants will be sent a link to complete the required law exam electronically. 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

Upload Application/Supporting Documents*

Application ( PDF's ONLY. Upload the application as one file. DO NOT Submit each page separately), Copy of Payment, SA6, AS4 Transcript, ASHA

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. AUD Assistant Application Fee

Submit Payment

Payment Receipt Transaction Number*

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

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. Please ensure the privacy rights form is signed and uploaded above.

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.

SA6*

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

Copy of ASHA Verification

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

Send me a copy of my responses

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