Form Pm 101 - Application For Registration As School Audiometrist - California Department Of Health Care Services Page 2

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INSTRUCTIONS
Personnel employed to conduct hearing tests in the schools of California, e.g.,
SCHOOL AUDIOMETRISTS, as defined in Section 44879 of the Education Code,
or qualified SUPERVISORS OF HEALTH, pursuant to Sections 49420 and 49452
of the Education Code, shall be REGISTERED AS SCHOOL AUDIOMETRISTS.
Training requirements are prescribed by Section 2950, California Code of
Regulations.
Applicants for REGISTRATION AS SCHOOL AUDIOMETRISTS shall submit the
following:
Completed Application, PM 101
 Official or a copy of a Transcript of Record (or official grade cards)
verifying satisfactory completion of required training in audiology and
audiometry
A registration fee of $10
MAIL THIS APPLICATION WITH TRANSCRIPT OF RECORD (or grade cards) and
$10 REGISTRATION FEE (payable to the California State Department of Health
Care Services) to:
California Department of Health Care Services
Accounting Section, Cashiers
MS 1101
P.O. Box 997413
Sacramento, CA 95899-7413
Direct
any
questions
to
the
Hearing
Conservation
Program
at
HearingConservationProgram@dhcs.ca.gov.
Page 2 of 2
PM 101 (05/15)

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