2017 Wisconsin Act 278, beginning August 1, 2018, prior to submitting an application for a credential, an individual may apply to the Department for a determination of whether the individual would be disqualified from obtaining the credential due to his or her conviction record. To apply for a predetermination, please fill out
Form 3085 and submit all required documentation specified on the form. Pursuant to
Wis. Stat. §
111.335(4)(e), the offenses or kinds of offenses that may result in a refusal, bar, or termination of licensure are published under Additional Resources on the left side of this page.
2017 Wisconsin Act 319, beginning August 1, 2018, an applicant for an initial credential may apply for a reduction of the initial credential fee that is equal to 10% of the initial fee. Qualification is based on the federal adjusted gross income being at or below 180% of the federal poverty guideline prescribed for the applicant's family household size by the United States Department of Health and Human Services. To determine eligibility please visit the
United States Department of Health and Human Services website prior to submitting
Wis. Stat. § 440.08(2), the required renewal date for the Anesthesiologist Assistant credential is 09/30/even years. Should you receive your initial credential in the months leading up to this date, you are still required to renew your license by the statutorily defined date.
Licensure is required for any person who practices as an anesthesiologist assistant, who holds themselves out as one authorized to practice as an anesthesiologist assistant or who uses the letters “A.A.” or any other designation that tends to represent the person as an anesthesiologist assistant.
Temporary licenses are available to applicants who are eligible to take, but have not passed the national exam. The Board may grant a temporary license once the application for licensure Form 2976, request for temporary license
Form 2979 and fees are received by the Department.
A temporary license expires on the date on which the board grants or denies an applicant permanent licensure or on the date of the next regularly scheduled examination required under
Wis. Stat. § 448.05(6) if the applicant is required to take, but has failed to apply for, the examination.
Pre-Credential Education Information
A bachelor’s degree and satisfactory completion of an anesthesiologist assistant program that is accredited by the Commission on Accreditation of Allied Health Education Programs (or by a predecessor or successor entity).
Application for Licensure
2976||Application For Licensure as an Anesthesiologist Assistant|
|3217||Application for Fee Reduction (If applying for a fee reduction, this form
must accompany Form #2976.)|
2977||Anesthesiologist Assistant Certificate of Professional Education|
2975||Request for National Examination Scores|
2979||Request for Temporary License for Anesthesiologist Assistant|
2829||Malpractice Suits or Claims Form (if applicable)|
|3085||Application for Predetermination
(Submit ONLY if you have been convicted of any felony, misdemeanor, or other violations of federal, state, or local law, including municipal ordinances, in this state or any other) |
2252||Convictions and Pending Charges|
3071||Fax Payment Form|