The CCC-A — Certificate of Clinical Competence in Audiology — is the gold-standard professional credential for audiologists in the United States. It's issued by the American Speech-Language-Hearing Association (ASHA) and signals that the holder has met rigorous academic, clinical, and examination standards in the field of audiology.
Unlike some certifications that are optional or supplementary, the CCC-A is functionally essential for most audiologists. Many states require it (or an equivalent) for state licensure. Hospitals, hearing clinics, and school systems routinely require it as a condition of employment. Receiving Medicaid and Medicare reimbursement for audiology services often requires the CCC-A. In practical terms, you can't build a full-scope audiology career in most settings without it.
ASHA issues two Certificate of Clinical Competence credentials:
These are separate credentials with separate requirements. A CCC-A holder is an audiologist; a CCC-SLP is an SLP. The two professions are related (both fall under ASHA's umbrella) but are distinct disciplines. You can hold both credentials if you're trained and certified in both areas, but this is uncommon.
This article focuses specifically on the CCC-A for audiology. If you're pursuing speech-language pathology certification, the CCC-SLP has its own pathway.
To apply for the CCC-A, ASHA requires you to meet all three of the following criteria:
The CCC-A requires a doctoral-level degree in audiology — specifically, the Doctor of Audiology (Au.D.). As of January 2012, ASHA requires a doctoral degree for new CCC-A certification; the previous master's-level pathway was discontinued for new applicants.
The Au.D. is a 4-year professional doctorate (similar in structure to medical school or law school) following an undergraduate degree. Programs must be accredited by the Council on Academic Accreditation in Audiology and Speech-Language Pathology (CAA) — only degrees from CAA-accredited programs qualify for CCC-A certification.
You must complete a minimum of 1,820 hours of supervised clinical experience. Of these:
Hour requirements and specifics can shift — always verify current requirements directly with ASHA at the time you're applying, as standards are periodically updated.
You must pass the Praxis Examination in Audiology (ETS Praxis, Test Code 5342). This is a computer-based standardized exam covering the full scope of audiology practice. It's administered by the Educational Testing Service (ETS) at authorized Prometric testing centers.
The Praxis in Audiology has approximately 130 scored questions and a 2.5-hour time limit. The passing score for ASHA CCC-A purposes is 162 (on a 100–200 scale). Some state licensure boards require higher scores; check your state's specific requirements if you're pursuing state licensure alongside ASHA certification.
The Clinical Fellowship is a supervised postgraduate period that used to be a separate requirement for new audiologists. Under the current Au.D. model, the extensive clinical training occurs within the Au.D. program itself (particularly through the fourth-year externship). The standalone CF requirement is no longer a separate step for Au.D. graduates — the clinical experience is embedded in the degree program.
However, some employers still structure postgraduate positions as "Clinical Fellowship" roles with additional mentorship and supervision, even if it's no longer an ASHA certification requirement. Check with your specific employer or state board about their expectations.
The Praxis in Audiology exam tests knowledge across the full scope of audiology practice. Understanding the content domains helps you study strategically rather than reviewing everything equally.
Anatomy and physiology of the auditory and vestibular systems, acoustics and psychoacoustics, neural bases of hearing, and speech perception. This foundational content supports clinical reasoning across all other practice areas.
The largest content domain — pure-tone audiometry, speech audiometry, immittance testing, auditory evoked potentials (ABR, ASSR, ECochG), otoacoustic emissions (OAEs), and specialized tests for specific populations (pediatric assessment, auditory processing evaluation). Deep knowledge of administration, interpretation, and clinical decision-making within these procedures is essential.
Videonystagmography (VNG), rotary chair testing, VEMP testing, and posturography. Vestibular assessment is a specialty area that many new graduates feel less confident in — invest preparation time here if you haven't had extensive clinical exposure.
Newborn hearing screening (NHS), school-based hearing screenings, industrial hearing conservation programs, and community screening programs. Understand the protocols, follow-up algorithms, and regulatory frameworks governing each.
Hearing aid selection and fitting (including verification and validation), cochlear implant candidacy and management, auditory rehabilitation, aural rehabilitation programs, and patient/family counseling. This domain reflects the treatment side of audiology practice.
ASHA Code of Ethics, scope of practice, documentation standards, billing and reimbursement (Medicare/Medicaid, private insurance), infection control, and supervision standards. The ethics questions on the Praxis are generally straightforward if you know the ASHA Code — review it directly.
Graduates of CAA-accredited Au.D. programs have covered the vast majority of Praxis content through their coursework and clinical training. The Praxis isn't a novel challenge — it's a comprehensive review of material you've already learned. That said, exam-specific preparation still matters.
ETS provides official Praxis Audiology practice tests and study companions. These mirror the real exam's question format more closely than any third-party resource. Always include official materials in your final prep phase.
Self-assess honestly: Are you confident on vestibular assessment? Pediatric audiometry? Cochlear implant candidacy criteria? Auditory processing disorders? Find your gaps and fill them specifically. General broad review is less efficient than targeted work on your actual weak spots.
Ethics questions appear on the Praxis and are essentially free points if you've read and understood the ASHA Code. It's not long — read it carefully in the weeks before your exam.
130 questions in 2.5 hours is about 1.15 minutes per question. Work through practice questions under realistic time pressure so you build pacing confidence before the real exam. Most questions shouldn't require extended deliberation if you know the material — slow yourself down only for genuinely complex clinical reasoning questions.
Once you've passed the Praxis and completed your degree requirements, you apply for the CCC-A through ASHA's online certification system. The application requires:
ASHA verifies your documentation and issues your CCC-A certificate. This process can take several weeks after submission. Many audiologists obtain state licensure simultaneously — state boards often accept the same documentation.
ASHA requires annual maintenance to keep your CCC-A current:
CEUs can be earned through ASHA-approved continuing education activities: conferences, webinars, self-study courses, clinical supervision of graduate students, and publications. Plan your CEU accumulation over the 3-year period rather than scrambling at the end.
Earning the CCC-A represents years of intensive academic study and clinical training. The Praxis exam is the culminating academic challenge — it's the last formal test before you can practice independently as a certified audiologist.
Prepare deliberately: review your weakest clinical domains, use official ETS practice materials, know the ASHA Code of Ethics, and practice under timed conditions. The exam is achievable for well-trained Au.D. graduates — and the credential it unlocks is the foundation of your audiology career. Take the preparation seriously, and walk into exam day ready to earn it.