Application for assessment of internationally educated audiologists and speech-language pathologists

First Name:

Last Name:

Gender: ☐ Female ☐ Male

Applying for membership as an/a: ☐ Audiologist ☐ Speech-Language Pathologist

Preferred contact information:

E-mail address:

Telephone number:

Are you a member of another Canadian professional association, college or licensing body in speech-language pathology or audiology?

☐ Yes ☐ No If yes, which one?

If no, are you applying concurrently to another Canadian professional association, college or licensing body in speech-language pathology or audiology?

☐ Yes ☐ No If yes, which one?

Have you submitted your credentials to be evaluated by the International Qualifications Assessment

Service (IQAS)? ☐ Yes ☐ No

Speech-Language & Audiology Canada Application Checklist:

☐ $500 Assessment fee (payable to SAC by Visa, MasterCard, certified cheque or money order)

☐ Official degree transcripts

☐ Complete course descriptions including hours of study

☐ Verified signed record of clinical practicum hours

☐ Official translation of documents if not in English

☐ IQAS or WES assessment report

The application fee is being paid by: ☐ VISA ☐ MC ☐ Certified Cheque ☐ Money Order

Credit Card Number: Expiry Date:

Credit Card Security Code: Signature:

Mail all documents and fee to: SAC, 1000-1 Nicholas St., Ottawa, ON K1N 7B7 Canada * All documents and fees must be received before the assessment can begin. The assessment will take

approximately 8 - 12 weeks.