Verification of Information - American Board of Child Language and Language Disorders

Verification of Information for Invited Board Certification

All Specialty Certification is awarded under the auspices of the ASHA guidelines. Every Board Certified Specialist must comply with the requirements as defined by CFCC/CCSC. As approved by the CCFC/CSCC, the ABCLLD has established a process by which we may grant Board Certification in Child Language by securing evidence that every Board Certified Specialist meets the requirements; therefore, please complete the information below.

Name and Credentials*

Upload Curriculum Vita*

Accepted file types: pdf, doc, docx, rtf, Max. file size: 10 MB.

Name of Employer*

Address of Employer*

Street Address City State / Province / Region ZIP / Postal Code Country

ASHA # / Equivalent Certification #*

Upload Copy of ASHA or Equivalent Certification Card*

Accepted file types: jpg, png, jpeg, pdf, Max. file size: 10 MB.

Work Email Address*

Work Phone Number*

Personal Email Address*

Home / Cell Phone Number*

Biography*

Please provide a brief bio that the ABCLLD could share representing your expertise as a Specialist in Child Language. This description should not exceed 250 words.

I wish to accept your invitation for certification as a Child Language Specialist. I am uploading my CV and a copy of my ASHA card or equivalent certification card. I understand that I will be required to pay the annual fee of $100 in December for the subsequent year.

I certify that I have met the requirements of 100 clock hours of intermediate or advanced continuing education related to child language and language disorders. These activities have occurred within the last 10 years.

Applicant e-Signature*

Today's Date*