Other Forms and Information

​​​​​Forms

FormDescription
1051SSN Exempt Form
(For applicants of initial license or renewal who do not have a Social Security Number.
Please mail original, notarized copy to: DSPS, Renewal Office, PO Box 8935, Madison, WI 53708-8935.)
2252​Convictions and Pending Charges
1229​Communicable Disease Form (only applicable to Health Professions)
​​3217
​Application for Initial Credential Fee Reduction
​3085​Application for Predetermination
​3071​Payment Form​
​3082​Wall Certificate with Wallet Card or Governor-Signed Wall Certificate Request Form
​LicCo​unts​Monthly License Counts

Information

TitleDescription
​1907
Disability Modification Request Form for Examinations
​2349​Requests for Modification of Examinations for Persons With Disabilities
2350​Professional Verification of Request for Modification
Military Licensure Benefits​Military Benefits Related to Licensure for Eligible Veterans, Service Members, and Spouses
Death of a Licensee​Procedure for Reporting the Death of a Licensee
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