ASHA Certificate of Clinical Competence (CCC) Guide 2026 October

What Is the ASHA Certificate of Clinical Competence?

The ASHA Certificate of Clinical Competence — known simply as the CCC — is the gold standard credential for speech-language pathologists and audiologists in the United States. Awarded by the American Speech-Language-Hearing Association, it signals that you've met rigorous standards for education, clinical training, and professional assessment.

There are two versions: CCC-SLP for speech-language pathologists and CCC-A for audiologists. If you're working in most school districts, hospitals, or private practice settings, holding the CCC isn't optional — it's expected. Many states actually tie their licensure requirements directly to ASHA certification.

Here's why it matters beyond just checking a box:

• Employers in healthcare and education typically require it for full-time positions
• It demonstrates accountability to evidence-based practice standards
• It's required for Clinical Fellowship supervision privileges
• Medicaid and Medicare reimbursement often hinges on CCC status

CCC Requirements at a Glance

The path to the CCC involves three major components: graduate education, a supervised Clinical Fellowship, and the Praxis exam. You can't shortcut any of them — ASHA verifies all three before granting certification.

Graduate education must come from a CAA-accredited program. The specific coursework requirements are detailed in ASHA's standards, covering areas like basic communication processes, clinical disorders, and research methods. Your program director will certify your academic preparation as part of the application.

The Clinical Fellowship is a full-time supervised experience you complete after graduation. It's 36 weeks minimum (or part-time equivalent) under a CCC-holder who provides mentorship and formal evaluation. Your CF mentor submits performance ratings to ASHA — so the relationship you build there matters.

The Praxis Exam: What You Need to Know

The Praxis Speech-Language Pathology exam (or its audiology equivalent) is the standardized test component of CCC certification. You'll take it through ETS, and your score goes directly to ASHA as part of your certification application.

Score Requirements

ASHA requires a minimum passing score of 162 on the SLP Praxis (on a 100-200 scale). Individual states may require higher scores for licensure — always check your state's requirements, not just ASHA's.

What the SLP Praxis Covers

The test spans the full breadth of clinical practice:

• Foundations and professional practice — research, ethics, ASHA standards, evidence-based practice
• Screening, assessment, evaluation, and diagnosis — across all disorder areas
• Planning and implementing intervention — treatment approaches, goal-writing, progress monitoring
• Communication disorders and differences — fluency, voice, articulation, language, AAC, swallowing

The exam is 132 scored questions plus some unscored pretest items. You have 2.5 hours. Most test-takers find the breadth — rather than the depth — to be the main challenge. You need to be solid across every disorder area, not just the ones you specialized in during grad school.

Maintaining Your CCC

The CCC isn't a one-and-done credential. You renew every three years and must complete 30 Certification Maintenance Hours (CMHs) per renewal period. At least 1 CMH must cover ethics content.

CMHs can come from workshops, webinars, courses, research activities, and other professional development. ASHA's learning platform tracks your progress, and you self-report completed activities.

Letting your CCC lapse matters — you lose the credential entirely if you miss a renewal cycle without requesting a waiver. Reinstatement is possible but involves reapplying and demonstrating you still meet current standards.

Clinical Fellowship Details

The CF is where you bridge graduate training and independent practice. Your CF supervisor — who must hold an active CCC in the same area — provides direct observation (at least 36 hours across the fellowship), formal feedback, and written performance ratings.

You and your supervisor complete interim and final reports using the CF Assessment Tool. ASHA reviews these as part of your certification application. If your CF doesn't meet standards, you may need to extend it — so communicate openly with your supervisor throughout.

Most new SLPs complete their CF in school settings or hospitals, though private practice and early intervention CFs are also common. The setting matters less than the quality of supervision and the breadth of cases you manage.

Pros and Cons at a Glance

Sample CCC Practice Questions

Try these questions from our free CCC practice tests. The correct answer and an explanation follow each question.

1. Who is qualified to mentor a Clinical Fellow?

   • A. Any licensed physician
   • B. An ASHA-certified clinician holding the CCC in the same area
   • C. Any master's-prepared professional
   • D. The program director only

   Answer: B. An ASHA-certified clinician holding the CCC in the same area

   The CF mentor must hold a current CCC in the fellow's area of certification.

2. To maintain the CCC, certificate holders must complete continuing education known as:

   • A. CMEs
   • B. CEUs / Professional Development Hours
   • C. PALS renewal
   • D. Board recertification exams

   Answer: B. CEUs / Professional Development Hours

   CCC holders must earn continuing education units to maintain certification across each interval.

3. During the Clinical Fellowship, what percentage of time must be spent in direct clinical contact?

   • A. At least 80%
   • B. At least 50%
   • C. At least 25%
   • D. At least 10%

   Answer: A. At least 80%

   At least 80% of the CF must involve direct clinical activities such as assessment and intervention.

4. The Clinical Fellowship must be completed over a minimum span of how many weeks at full-time?

   • A. 12 weeks
   • B. 24 weeks
   • C. 36 weeks
   • D. 52 weeks

   Answer: C. 36 weeks

   A full-time CF must extend at least 36 weeks to satisfy ASHA standards.

Take the full CCC practice test

How to Prepare for the Praxis

The Praxis isn't a clinical practicum — it's a standardized test. That means preparation looks different than your clinical training did. You'll want to review disorder categories systematically, not just the ones you saw most in grad school.

Start by identifying your weaker areas. If you sailed through fluency coursework but always struggled with swallowing, lead with dysphagia review. The ETS study companion for the SLP Praxis outlines the content categories and their approximate weight — use it as a checklist.

Practice tests are essential. Not because the questions will repeat, but because timed practice under realistic conditions builds the mental stamina you need for 132 questions in 150 minutes. Use the CCC practice tests available here — they're designed to mirror the real exam's content distribution and difficulty level.

Most candidates who fail the first time cite running out of time or getting rattled by unfamiliar terminology. Both are solvable with preparation. Pace yourself at about one minute per question, flag difficult items and return to them, and don't second-guess answers you felt confident about on your first pass.

The CCC is achievable. Thousands of SLPs earn it every year. With a solid study plan, consistent practice, and a clear understanding of what ASHA's standards require, you'll be in strong shape for both the exam and the fellowship.