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.
Pursuant to 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 at https://aspe.hhs.gov/poverty-guidelines, prior to submitting Form 3217.
Wis. Stat. § 440.08 (2), the required renewal date for the Dental Hygienist credential is 09/30/odd 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.
Pre-Credential Education Information
Graduate from a dental hygiene school accredited by the American Dental Association Commission on Dental Accreditation.
Application for Licensure
511||Application For Dental Hygiene License|
|3217||Application for Fee Reduction (If applying for a fee reduction, this form must accompany the application for the credential.)|
1463||Dental Hygiene Certificate of Professional Education|
2853||Application for Temporary Permit to Practice Dental Hygiene Without Compensation|
||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)|
||Convictions and Pending Charges|
3071||Fax Payment Form|
Application to Administer Anesthesia/Conscious Sedation
2455||Application For Dental Hygiene Certificate to Administer Local Anesthesia|
2458||Certification of Inferior Alveolar Injection |
2457||Local Anesthesia Certificate of Completion |
|3163||Application for Dental Hygiene to Administer Nitrous Oxide|
3164||Nitrous Oxide Certificate of Completion|