Forms/Applications

Online (web-based) Forms

Relinquish License due to Exemption as AuD

2012 License Renewal Online Application

Request for Invoice to make payment electronically online

Address Change form

PDF Forms for printing and mailing

Complaint Form for submission to Committee on Investigations

Registered Sponsor Application (for Au.D. not licensed by this Board)

Verification of Licensure Form

Application for Licensure

Application for Apprentice Registration

Application for Renewal/Replacement of Apprenticeship Certificate

License Renewal Application

Application for CEU Program Accreditation

Log of Supervision

To Become an Authorized Calibrater

Plan for Completing the Supervision
Requirements for the Apprenticeship

Order Form for a Simulator Practice CD

Report of the Apprenticeship Experience

P.O. Box 97833, Raleigh, NC 27624-7833  -  PH: 919.834.3661  -  FAX: 919.834.3665  - Email: info@nchalb.org