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          20:79:01:03.  Information required. The board shall determine qualification for licensure based on information given on the application form and on any additional information the board considers necessary for clarification of submitted material. Any person seeking licensure must include with the application the following information:


          (1)  Type of biennial license;


          (2)  Name, mailing address, social security number, telephone number, and date of birth of applicant;


          (3)  Name of employer, address, telephone number, and past employment history, if applicable;


          (4)  If not ASHA certified, the name of current and postgraduate supervisor, license number, telephone number, and address;


          (5)  A copy of Department of Education speech-language pathologist certificate (if applicable as a bachelors level speech language pathologist);


          (6)  Name and location of any college or university attended, including postgraduate (provide official transcripts of highest degree obtained);


          (7)  If not ASHA certified, record of supervised postgraduate professional experience;


          (8)  If not ASHA certified, signed releases of information for state boards and current and past supervisors and employers; and


          (9)  If not ASHA certified, evidence of passing the Praxis examination, if required.


          Source: 39 SDR 220, effective June 27, 2013.

          General Authority: SDCL 36-37-14.

          Law Implemented: SDCL 36-37-4, 36-37-12, 36-37-14, 36-37-15, 36-37-16, 36-37-17, 36-37-18.


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