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Verification of Hours, Licensure, and Certification Forms

Those requesting verification of 25 hours of clinical observation for licensure by the State Board of Examiners for Speech-Language-Pathology and Audiology must submit the following to Dr. Valarie Fleming:

  1. Check in the amount of $25 made payable to the CDIS Fund
  2. Completed Hours Form


If the Name and University Name lines of the Verification of Hours Form are not completed by you, then your hours will not be processed. Enter the University name as it currently is (Texas State University), NOT as it was at the date of graduation. DO NOT ENTER SS#. The form will be returned to you, NOT submitted to the licensing board.  Thank you for your assistance in making it as easy as possible to help you in a timely manner.