State of Wisconsin Department of Regulation & Licensing
Ensuring the availability of safe and competent professional services 		Secretary Celia Jackson
 Secretary Jackson
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Audiologist - Forms

Petitions for refunds must be in writing and may be granted only if the criteria set forth in Wis. Admin. Code s. RL 4.06 are met.

Audiologist Application Packet

Form #
Title
Application for Licensure to Practice Audiology
Temporary License Request to Practice Audiology
Audiologist Certificate of professional Education (This form needs to be completed by your school.)
Request for Verification of Certification (Compelete this form and forward to the American-Speech-Language Hearing Association)
Convictions and Pending Charges
Notices (Department Information)

Other Information / Forms

Title
Study Guide for Hearing Instrument Specialist and Audiologists
Continuing Education Approval Request Form Information

Continuing Education Approval Request Form
Disability Modification Request Form for Examinations
Professional Verification of Request For Modification

 

 

 

Last updated: Wednesday, October 11, 2006