Waiver of Continuing Education while not actively practicing:

I,   First Name*   Last Name*   , being duly sworn, attest that: 

1. I am a licensed clinical speech and language pathologist in the State of Connecticut. 

2. During the exemption period from    Date*   to   Date*   . I did not/will not actively engage in the practice of speech and language pathology in the State of Connecticut; 

3. I, therefore, claim an exemption for the above-specified period from the continuing education requirements that specifies that each licensee actively engaged in the practice of speech and language pathology must complete a minimum of 20 contact hours during the registration period. 

4. I understand that, should I resume the practice of speech and language pathology in the State of Connecticut, I must complete 7 hours of continuing education within six (6) months of returning to active practice. 

Waiver of continuing education due to medical disability/illness:

I hereby declare my eligibility for a waiver of the continuing education requirements based on a medical disability/illness pursuant to Section 20-411a(f), Connecticut General Statutes. I certify that due to a medical disability/illness, I am unable to complete the continuing education requirements from   Date*      to   Date*   . 

5. The above statements are true to the best of my knowledge and belief.