1. (a) Unless otherwise indicated, an applicant must submit all required information and documentation of credentials on department-approved forms.

2. (b) An applicant for an assistant in speech-language pathology license must submit the following required documentation:

   1. (1) a completed application on a department-approved form;
   2. (2) a Supervisory Responsibility Statement Form completed by the licensed supervisor who agrees to accept responsibility for the services provided by the assistant and signed by both the applicant and the proposed department-approved supervisor or submitted in a manner prescribed by the department;
   3. (3) an original or certified copy of the transcript(s) showing the conferred degree of relevant course work which also verifies that the applicant possesses a baccalaureate degree with an emphasis in speech-language pathology and/or audiology;
   4. (4) if not previously submitted, a Clinical Observation and Clinical Experience Form completed by the university program director or designee of the college or university training program verifying the applicant completed the requirements set out in §111.50(a)(3);
   5. (5) for an applicant who did not obtain the hours referenced in paragraph (4), a Clinical Deficiency Plan Form to obtain the hours lacking;
   6. (6) proof of successfully completing the Texas Jurisprudence Examination under §111.23; and
   7. (7) the initial application fee required under §111.160.
3. (c) An applicant for an assistant in speech-language pathology license must submit a completed legible set of fingerprints, on a form prescribed by the department, to the Department of Public Safety for the purpose of obtaining criminal history record information. An applicant must successfully pass a criminal history background check.
4. (d) An applicant must complete all licensing requirements within one year from the date the application was submitted. After that year an applicant will be required to submit a new application and all required materials in addition to paying a new application fee.

Source Note:The provisions of this §111.55 adopted to be effective October 1, 2016, 41 TexReg 4441.