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Application Payment - Information

All sections of the form are mandatory and must be completed. If you have any questions you may contact the board office at (775) 787-3421.

Standard Application Fee:
  • $250.00
  • $125.00 Military Fee
Provisional License Fee:
  • $250.00
  • $125.00 Military Fee
Temporary License Fee:
  • $200.00
  • $100.00 Military Fee
Standard Audiologist Application with Dispensing Endorsement Fee:
  • $300.00
  • $175.00 Military Fee

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Personal Information

Please complete the information below.

Application Fee

Please select the application fee you are paying.

Military Service or Veteran Status
Declaration
I declare, under penalty of perjury, all the information supplied herein is to the best of my knowledge true, accurate and complete.