You finished your master's. You passed Praxis. And now somebody's handed you a packet that says CF SLP and your eyes glaze over. Same for everyone. The clinical fellowship year is the bridge between being a graduate student and being a fully credentialed speech-language pathologist with the CCC-SLP after your name — but the rules feel like alphabet soup until you actually start one.

ASHA wants 1,260 hours. Or 36 weeks. Or both, depending on how you read the chart. You need a supervisor. You need three evaluations. You need to file paperwork that nobody warned you about during your clinical placements.

This guide walks through the whole thing — what counts as a CF, who can supervise you, what gets evaluated, how much you'll actually earn during the year, and what happens after you finish. We'll go setting by setting (schools, hospitals, SNF, outpatient, private practice), pay range by pay range, and timeline by timeline. By the end you'll know what to look for in a CF position, which red flags to walk away from, and exactly what paperwork you need to submit to ASHA when you're done. Let's get into it.

One thing to clear up before we start. The clinical fellowship used to be called the CFY — clinical fellowship year — and you'll still hear that term constantly from supervisors who graduated before 2020. ASHA officially shortened it to CF in their current standards, partly because not everyone finishes it in twelve months.

Schools commonly stretch a CF across two contract years. Hospitals sometimes wrap one up in nine months. So whether your senior colleagues call it CF or CFY, you're talking about the same thing — the supervised postgraduate practice period required to earn your cf slp credential through the American Speech-Language-Hearing Association.

Let's start with the basics. CF stands for Clinical Fellowship. It's the supervised postgraduate practice period the American Speech-Language-Hearing Association requires before you can be awarded the Certificate of Clinical Competence in Speech-Language Pathology — the CCC-SLP. Without finishing your CF, you can't be ASHA-certified. Without ASHA certification, most states won't grant a full SLP license. So the CF isn't optional padding. It's a hard gate between graduation and full professional practice.

Eligibility to start a CF is straightforward on paper. You need to have completed a master's degree in speech-language pathology from a program accredited by the Council on Academic Accreditation (CAA), which is ASHA's accrediting arm. You need to have passed the Praxis Subject Assessment in Speech-Language Pathology — exam code 5331, costs $146, four hours, 132 multiple choice items. Most students take Praxis during their final semester of grad school, with a smaller cohort taking it shortly after graduation. Once those two things are checked off, you're eligible to begin clinical fellowship work the day after graduation.

What the CF actually is, mechanically, is a supervised first job. You work as a speech-language pathologist under the title CF-SLP or Clinical Fellow, with a qualified mentor providing oversight. You see real clients. You write real treatment plans. You bill real units when the setting allows.

The key difference from full practice is that your supervisor signs off on your clinical decisions, observes you directly for a portion of your hours, and submits formal evaluations of your performance at three points across the fellowship. When all three evaluations come back favorable, you submit final paperwork to ASHA and your full cf slp credential is awarded.

Now — the hour and week requirements. This is where the confusion starts because ASHA writes the standard two ways and both ways have to be true at the same time. You need a minimum of 1,260 clinical practice hours. AND you need at least 36 weeks of full-time experience, where full-time means an average of 35 hours per week or more.

If you're working part-time at, say, 20 hours weekly, you can still complete the CF — it just takes longer, calculated proportionally. ASHA caps the total fellowship window at four years from the day you start, so you can't drag a part-time CF out indefinitely.

The 1,260 hours have to be direct clinical practice. That means time spent evaluating, treating, documenting client care, counseling families, attending care conferences about your caseload, and writing clinical reports. Administrative time, lunch breaks, drive time between visits, and continuing education hours don't count toward the 1,260. Most CFs in school settings hit the hour minimum well before they hit the week minimum because the school calendar limits weeks. Most CFs in medical settings — hospitals, SNFs, outpatient — hit the week minimum first because they're working full 40-hour weeks year-round.

One detail almost nobody gets warned about. The 35-hour-per-week full-time average is computed across the entire CF, not within each week. So if you take a week off for moving or a family event or a wedding, you don't fail your CF — you just need other weeks to compensate. Many CFs include scheduled vacation time. ASHA's rules accommodate normal employment practices. The key is that your supervisor signs off on your hours log, and your average across all weeks meets the bar.

Picking your CF setting matters more than people realize. The setting you finish your fellowship in tends to shape the first three to five years of your career — partly because of skill specialization, partly because of professional networking, partly because hiring managers assume you'll keep doing what you trained in. If you complete a CF in a school district, your first non-CF jobs will mostly be school positions. If you do a hospital CF, you'll have an easier path into medical SLP work down the road. So pick deliberately.

Schools are the most common CF setting in the US. The reason is supply and demand — school districts have huge SLP caseloads relative to clinician availability, and most districts have funding to pay a CF salary. Pay ranges from about $50,000 to $62,000 in most regions for a school-based CF, with higher numbers in California, the Northeast, and a few specific metro areas. The trade-off is summer break (unpaid in most contracts), high caseload numbers (60-80 students is common), and heavy paperwork tied to IEPs and Medicaid billing.

Hospitals pay better — typically $58,000 to $72,000 for a CF — but the trade is intensity. You'll see medically complex patients, write detailed daily notes, attend rounds, and learn the rhythm of acute care. Documentation is heavy. Productivity expectations are high. But the clinical learning curve is the steepest of any setting, which is why many SLPs who want medical careers specifically target hospital CFs even when school positions pay similarly.

Skilled nursing facilities pay surprisingly well — often $62,000 to $75,000 for a CF — but the productivity expectations are usually 85% to 90% billable time, which is brutal for a new clinician still learning to document quickly. SNFs are heavy in adult dysphagia, post-stroke recovery, cognitive-communication therapy, and dementia care. If those populations interest you long-term, SNF CFs can be excellent. If not, the burnout risk is real and reported turnover in SNF CF positions is the highest of any setting.

The three-segment evaluation system is what most CFs worry about and what almost none of them need to worry about. The forms are called the SLPCF Skills Inventory (SLPCF-SI), and the same instrument is used by every supervisor regardless of setting. Each segment evaluates a specific set of skills against a rubric — competent, satisfactory, needs improvement.

The vast majority of CFs receive satisfactory or competent ratings across all three. Outright failure of a segment is uncommon. When a segment is rated unsatisfactory, the typical outcome is an extension of the CF by additional weeks until competency is demonstrated, not termination of the fellowship.

That said, the evaluations aren't meaningless. They form the documented record that you've met ASHA's competency standards across the full domain of SLP practice. If you switch settings mid-CF (say, you start in a school and move to a clinic at week 18), your second supervisor will see the prior evaluation and use it as context for theirs. Strong segment 1 and 2 evaluations make a setting switch much easier than weak ones, where the new supervisor may insist on restarting some of the assessment focus areas.

One thing worth knowing — your supervisor can extend your CF beyond the 36-week minimum if they believe you need more supervised time before achieving full certification. This isn't punishment. It's a clinical judgment that you'll be a stronger clinician with a longer fellowship. Most extensions are 4 to 12 weeks. Refusing to accept an extension is your right, but you'd need to complete the rest of the CF with a different supervisor, which is logistically difficult and often delays your cf slp credentialing anyway. The smoother path is almost always to accept a reasonable extension and finish strong.

Let's talk money. CF year pay is consistently lower than full CCC-SLP pay, which feels rough when you're carrying graduate student loans and trying to start your adult life. The reason is that you're being supervised — employers are paying for a supervisor's time on top of yours, and they price the position accordingly. Once you finish the CF and the supervision overhead drops off, most positions either convert to a higher pay tier automatically or you negotiate up at the one-year mark.

National pay ranges for CFs in 2026 roughly look like this. School-based CFs typically earn between $50,000 and $62,000 depending on district funding, geographic region, and contract length (9-month versus 10-month contracts). Outpatient clinic CFs typically run $55,000 to $68,000 with year-round paid weeks.

Hospital CFs run $58,000 to $72,000 with the higher end concentrated in urban academic medical centers. SNF CFs run $62,000 to $75,000 but with the productivity grind we discussed earlier. Home health CFs are less common but exist, usually paid per-visit which can work out to $65,000 to $80,000 if your geographic territory is dense enough to keep your visit count high.

For comparison, full cf slp earnings after the CF year typically run $75,000 to $95,000 in the same settings, with hospital and SNF roles trending higher than schools. That's roughly a 30% to 45% pay jump for the same work once supervision overhead is gone. If you stay with the same employer through the CF and into full certification, negotiate the jump explicitly at the credentialing milestone. Don't assume it'll happen automatically — about 40% of employers will quietly leave you at CF wages if you don't ask.

One quiet pattern in CF compensation. Sign-on bonuses are common in SNF and home health roles, less common in schools and hospitals. If a sign-on bonus is offered, read the contract carefully — most include a one-year service requirement that triggers repayment if you leave early. CF roles often include relocation assistance for clinicians moving to underserved areas. Both bonuses and relocation packages are negotiable. Don't accept the first offer without asking what flexibility exists. Worst case they say no. Best case you start your career a few thousand dollars ahead of where you would have.

One topic that catches CFs off guard — paperwork. You register your CF with ASHA within 30 days of starting (form CF-1). You submit segment evaluations as each one is completed (forms CF-2 through CF-4). You submit a final completion form once you've hit both the 1,260 hours and 36 weeks (form CF-5). All of these forms live in the ASHA member portal. The total fees for the CF registration plus final certification application come out to around $455 for your first year of CCC-SLP membership.

The four-year clock is the thing nobody warns you about hard enough. The day you start your CF, ASHA starts a four-year window. You have to complete all 1,260 hours and 36 weeks (or proportional part-time equivalent) within those four years. If you stretch the CF beyond four years — usually because of a long medical leave, multiple part-time gigs, or extended unemployment between roles — ASHA can require you to start over. Starting over means re-passing Praxis, re-registering, and re-beginning hours from zero. Track your start date and projected end date. Build in margin.

If you complete your CF in a state with separate SLP licensure (which is most states), you'll need to apply for state licensure independently. State licensure usually requires CCC-SLP plus a separate state application, fingerprinting, and a state-specific jurisprudence exam. The state license is what legally lets you practice — the CCC-SLP is what makes you nationally credentialed. Most clinicians hold both, and most employers won't hire you long-term without both in place.

State licensure timelines vary wildly. California's BBS application processes in 4 to 6 months. Texas can be 8 to 12 weeks. Some states issue temporary practice permits while your application is pending — others don't. Research your specific state's rules before you finish your CF, because the gap between CF completion and state license issuance is when many new SLPs hit a brief employment crunch. Talk to your employer early so they can extend your CF terms as needed while you finalize state credentialing.

Finding a CF position is a job hunt that looks different from most. You're applying not just to a workplace but to a supervisor — and the quality of your supervisor matters more than the prestige of the employer. Ask interviewers directly: how many CFs have you mentored? Can I speak with a recent CF you supervised?

Online job boards are useful but not where most CF positions get filled. ASHA Career Portal lists more CF jobs than any other site. SLP Jobs is the second-best general source. State-specific Facebook groups often surface CF openings before they hit national boards. LinkedIn is decent for hospital and SNF roles but weak for school district positions, which tend to live on district websites and state department of education boards.

So what happens after the CF? The day your final paperwork is approved by ASHA, you're a full CCC-SLP. Your wage typically jumps. Your independence expands — you can write your own treatment plans without cosignature, bill insurance directly, and (after nine months plus the supervision course) supervise the next generation of CFs yourself. You'll need to maintain certification with 30 continuing education units every three years, paid by either you or your employer. CEU options include ASHA-approved courses online and in-person, state association conferences, and self-study modules.

The first full year after CF is when many clinicians make their first major career pivot. School-based CFs sometimes move to medical SLP roles or vice versa. CFs who chose a setting based on availability rather than passion now have the credentials and confidence to switch. The first three to five years post-CF are typically when clinicians specialize — voice, swallowing, AAC, accent modification, pediatric feeding, neurogenic disorders. Specialty certifications (BC-S in swallowing, BC-ANCDS in adult neurogenic communication, etc.) become accessible after some years of focused practice.

One final point worth making. The CF year is hard. Imposter syndrome is universal. Productivity expectations feel impossible in the first few months. Documentation eats your evenings. You'll have client moments that feel like wins and moments that feel like total failures within the same hour. All of this is normal. Every CCC-SLP you know walked through the same year. Your supervisor walked through it. Your professors walked through it.

You're not unusual for finding it hard. You're following a path thousands of clinicians have completed, with a credentialed mentor walking beside you. Lean on your colleagues, lean on online SLP communities, and remember that the goal isn't to feel ready — it's to keep practicing while you become ready. Becoming a competent cf slp takes time, repetition, and reflection. Twelve months from now you'll be a different clinician than you are today.

One question that comes up constantly — what if you don't pass Praxis on the first try? Easy answer: you can retake it as many times as you need within ASHA's window, and most states require only that you pass eventually, not that you pass on a particular attempt. The score you submit to ASHA for the CF registration is your highest valid score, not your most recent. Many practicing SLPs took Praxis two or three times. It doesn't follow you. It doesn't appear on your resume. It doesn't affect your CF eligibility once you pass.

What about reciprocity if you start your CF in one state and finish in another? Your CF is registered with ASHA, not with a state. So if you move from Texas to Colorado mid-CF, you don't lose your fellowship hours. You'd need to coordinate with a new supervisor in Colorado and notify ASHA of the supervisor change, but your hours and weeks carry forward intact. State licensure does need to be applied for in your new state, and the timing of that affects when you can legally practice — but the CF itself is ASHA-tracked and portable across state lines.

One important caveat. If your new state requires a different supervisor credentialing than your prior one (some states layer additional supervision rules on top of ASHA's), confirm in advance that your new supervisor meets both ASHA's standards and the new state's. Some states require state-licensed supervisors. ASHA membership alone doesn't always cover this. Read your destination state's SLP practice act before you commit to a move mid-fellowship. Save yourself the headache.

And finally — what to do if your CF goes badly. If you're struggling clinically, your supervisor is unsupportive, your workplace is toxic, or your evaluations are coming back unsatisfactory, you have options. You can request a supervisor change. You can request a workplace change with the same employer. You can leave the position entirely and find a new CF role — your accumulated hours and weeks transfer with you, though you'd need a new supervisor sign-off arrangement.

ASHA has a CF dispute resolution process for truly broken supervisor relationships. Use it if you need to. Don't suffer through a broken CF year hoping it'll improve. Twelve months is a long time when the workplace is hurting your cf slp learning. Better to course-correct early than survive a year that doesn't serve your growth.