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Application Checklist & Forms

Effective January 1, 2014
the Administrative Track, 100 clinical hours in dysphagia are required each of the 3 years prior to applying for the BCS-S, but in addition, the applicant must have a total of 450 total hours in the 4 years (48 months) prior to application date.  This change meets the ASHA requirement for board certification.

Effective January 2, 2018 
All applicants must document receipt of at least 7.5 CEUs that relate to dysphagia within the last 3 years.  A minimum of 4.5 of the CEUs need to be ASHA sponsored courses and up to 3.0 of the CEUs may be non-ASHA sponsored continuing education activities. In addition, at least 40% (or 3.0 CEUs must be from in-person conferences).

Applicants whose primary hours in working with persons with dysphagia are completed in a private practice setting must show proof of billing for dysphagia services using the appropriate billing codes.  

Effective March 1, 2019
No paper applications will be accepted after March 1, 2019!  Please plan accordingly and use the online application form after this date.

Application Form

Application Fee: Click here to pay online

Online form:  Available here!!
Please note: No paper copies of the application will be accepted after March 1st. You have the ability to save information for  up to 3 months using the online application so please plan accordingly.

Appendix A-D: Available here!

Recommendation Form
Microsoft Word format: Recommendation Form

Online form:  Available here!

Verification of Hours Form
Microsoft Word format:  Verification of Hours Form

Online form:  Available here!


 If you are unable to save the file to your computer, try downloading a newer version of Adobe or email and we will email the forms to you in another format.

Please make sure all sections of the application are complete and your application is typed.  Any handwritten applications will NOT be accepted.