(A) All applications for a speech-language pathology student permit shall be submitted to the board at its principal office on forms prescribed by the board. The submitted application shall be typewritten or printed in ink.
(1) Submission of the application shall certify that all statements are true and complete.
(2) A photograph of the applicant shall appear in the space provided upon the hard copy application form. It shall be an unretouched, passport size photograph taken within six months of the date of application, and the face shall be portrayed not less than three-fourths inch width.
(3) All applications must be accompanied by a non-refundable fee of fifty dollars, which is to be paid at the time the application is filed with the board.
(4) All applications, evidence, statements and documents shall be retained by the board.
(5) All applications must have the signature of the college or university designee.
(6) All applications must include documentation verifying the applicant's completion of one year of graduate study in speech-language pathology and twenty-five hours of observation and seventy-five hours or more of clinical experience signed by the college or university designee.
(7) The plan for the speech-language pathology student permit holder will include:
(a) The practice setting for the speech-language pathology student permit holder.
(b) The signature and license number of the supervisor for the speech-language pathology student permit applicant.
(c) The frequency, method and scope of supervision.
(B) Any change in supervision or practice setting will require a new application and plan. The student permit holder will not practice until a new application and plan has been approved by the board.
(C) A student permit holder may apply for a one year extension of the permit by providing the following:
(1) A statement of the reason for extension for the student permit.
(2) Completion of a second student permit application and plan.