1. Name – Provide your legal name in the spaces provided. This includes Last Name, First Name, Middle Name, and Suffix (if applicable, such as Jr., Sr., II).
2. Name on Transcript(s) – If the name on your transcript is different from your legal name, make sure to complete this field.
3. Date of Birth – Provide your birthdate.
4. Social Security Number – Your social security number is required by Texas law to obtain a license and may be disclosed to agencies authorized to assist in the collection of child support payments.
5. Email Address – Provide your email address if you agree to receive licensing communications and notices via email. You can revoke this authorization in writing if needed.
6. Personal Phone Number – Provide a telephone number, including the area code, where you can be reached during the day.
7. Business Phone Number – Provide the telephone number, including the area code, of your business.
8. Mailing Address – Provide your current mailing address. This can be a post office box.
9. Professional License – Indicate if you possess a professional license, certificate, or registration issued by another state, jurisdiction, or territory. If yes, complete the license verification form.
10. Disciplinary Action History – Indicate if you have ever had a professional license, certification, or registration suspended, canceled, revoked, or denied in any state.
11. Voluntarily Surrendered License – Indicate if you have ever voluntarily surrendered any professional license, certificate, or registration.
12. Current Employment – List the contact information for your current employer.
13. Academic Training – List all colleges and universities attended. Attach additional pages if necessary.
14. Criminal History – Indicate if you have ever been convicted of, or placed on deferred adjudication for, any misdemeanor or felony. Texas allows you to have your criminal history evaluated before submitting your application.
15. Statement of Applicant – Carefully read the statement before dating and signing your application.
Checklist of Required Documentation:
- Original or certified copy of your transcript(s) showing the conferred degree
- Copy of your Praxis score report
- Texas Jurisprudence Exam certificate of completion
- Report of Completed Speech-Language Pathology Internship Form
- Additional documents if the internship was completed out-of-state
- ASHA Certificate of Clinical Competence, if applicable
Application Information for Military Service Members, Veterans, and Spouses
The Texas Department of Licensing and Regulation offers specific licensing options for military service members, veterans, and their spouses. Complete the Military Service Member, Military Veteran, or Military Spouse Supplemental Application (PDF) and attach it with your license application.
Send your completed application and required documents to:
TDLR
P.O. Box 12157
Austin, TX 78711-2157
For additional information and questions, visit the TDLR website or reach Customer Service via webform. Representatives are available Monday through Friday (excluding holidays) at (800) 803-9202 (in-state only), (512) 463-6599, or Relay Texas-TDD: (800) 735-2989.
For more information, please follow this link.
