Application Form for Board Certificationas a Specialist Child Language Have you read the Overview of the Application Process PDF and determined you are ready to apply? If so, to begin the application process for Board Certification in Child Language, complete this form and submit your payment of $250. This payment is nonrefundable.First Name(Required) Last Name(Required) Credentials(Required) Home Address(Required) Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Primary Phone Number(Required)Secondary Phone NumberWork Email Address Personal Email Address(Required) ASHA #(Required) How did you hear about Board Certification in Child Language?(Required)Product Name(Required)Total
