Do you currently possess licensure as a Speech Pathologist issued by the California Speech-Language Pathology and Audiology and Hearing Aid Dispensers' Board?
Yes
No
If you answered yes to question #1, identify your license number and date of expiration.
2.
Do you possess a Certificate of Clinical Compency in Speech Pathology issued by the American Speech-Language-Hearing Association?
Yes
No
If you answered yes to question #2, identify your certificate number and the expiration date.