Predetermination
Pursuant to
2017 Wisconsin Act 278, beginning August 1, 2018, prior to submitting an application for a credential, an individual may apply to the Department for a determination of whether the individual would be disqualified from obtaining the credential due to his or her conviction record. To apply for a predetermination, please fill out
Form 3085 and submit all required documentation specified on the form. Pursuant to
Wis. Stat. §
111.335(4)(e), the offenses or kinds of offenses that may result in a refusal, bar, or termination of licensure are published under Additional Resources on the left side of this page.
License Information
Fee Reduction
Pursuant to 2017 Wisconsin Act 319, beginning August 1, 2018, an applicant for an initial credential may apply for a reduction of the initial credential fee that is equal to 10% of the initial fee. Qualification is based on the federal adjusted gross income being at or below 180% of the federal poverty guideline prescribed for the applicant's family household size by the United States Department of Health and Human Services. To determine eligibility please visit the United States Department of Health and Human Services website prior to submitting Form 3217.
Per
Wis. Stat. § 440.08(2), the required renewal date for the Audiologist credential is 01/30/odd years. Should you receive your initial credential in the months leading up to this date, you are still required to renew your license by the statutorily defined date.
Temporary License
A temporary license may be granted to an applicant who has received their Au.D degree and need to schedule for the next available Audiology Practical Exam.
Temporary license may be issued for a period not to exceed 12 months and may be renewed once for 12 months or longer, at the discretion of the Hearing and Speech Examining Board, if the applicant fails an examination for Audiologist licensure under Wis. Stat. § 459.26(2)(a) or (b), and applies to take the next available examination, or if the applicant shows, to the satisfaction of the Board, sufficient cause for the renewal.
Pre-Credential Education Information
An applicant must submit evidence satisfactory to the board that he or she has satisfied one of the following:
- Completed a supervised clinical practicum and received a master's degree in audiology from a college or university approved by the Board.
- Completed education or training that the Board determines is substantially equivalent to the requirements for licensure under par. (a), that may include evidence that the applicant has been granted an Au.D. degree from a college or university approved by the Board.
Application for Licensure
| Form | Description |
|---|
|
1986 | Application for Licensure to Practice Audiology |
3217
| Application for Fee Reduction (If applying for a fee reduction, this form must accompany Form #1986.)
|
|
1985 | Audiologist Certificate of Professional Education (This form needs to be completed by your school) |
|
1980 | Temporary License Request to Practice Audiology |
|
1977 | Request for Verification of Certification (Complete this form and forward to the American-Speech-Language Hearing Association) |
|
2829 | Malpractice Suits or Claims Form (if applicable) |
| 3085 | Application for Predetermination (Submit ONLY if you have been convicted of any felony, misdemeanor, or other violations of federal, state, or local law, including municipal ordinances, in this state or any other) |
|
2252 | Convictions and Pending Charges |
|
3071 | Fax Payment Form
|