Applications - Forms

For information about applying for a Dyslexia Therapist or Dyslexia Practitioner license, please select the "Requirements" link found under the "Apply for a New License" tab on the left side of your screen.

Obtain a copy of the following publications now - click on your selection. 

Application for Licensed Dyslexia Therapists or Licensed Dyslexia Practitioners

• Application for Licensed Dyslexia Therapist or Dyslexia Practitioner (Word format, 73 KB) 
• Application for Licensed Dyslexia Therapist or Dyslexia Practitioner (Adobe Acrobat format, 58 KB) 

Renewal Form

• Renewal Form (Word format, 67 KB)
• Renewal Form (Adobe Acrobat form, KB)

Change of Address Form

• Change of Address Form (Word form, 64 KB)
• Change of Address Form (Adobe Acrobat form, 45 KB)

Name Change &/or Duplicate/Replacement License Request Form

• Name Change and Duplicate License Request Form (Word form, 36 KB)
• Name Change and Duplicate License Request Form (Adobe Acrobat format, 22 KB)

Consumer Complaints Sign

Licensees in private practice are required to notify each client, or minor client’s parent or legal guardian, with the name, address, and telephone number of the Department of State Health Services for the purpose of directing complaints to the department. Licensees may choose to provide this information on a sign prominently placed in the primary place of business, on a written document, such as an agreement or contract for services, or in an informational brochure provided by the license holder. See rule §140.586 (29) for more information. Licensees may choose to print off and post the following sign.

• Consumer Complaints Sign (Word format, 73 KB)
• Consumer Complaints Sign (Adobe Acrobat format, 24 KB)

To access documents in Adobe Acrobat format, you must download the Acrobat Reader software. Please see the DSHS file viewing page for more information and a link to the Adobe website.