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 Podiatrist credential is 10/31/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.
Pre-Credential Education Information
Graduate from an approved school. The board recognizes as approved those podiatric medical schools recognized and approved at the time of the applicant's graduation by the
Council on Education of the American Podiatry Medical Association.
Application for Licensure
Application by Endorsement of Exam Scores or Re-Registration (License Expired five (5) Years or more)
575||Application for Licensure to Practice Podiatric Medicine and Surgery|
|3217||Application for Fee Reduction (If applying for a fee reduction, this form must accompany the application for the credential.)|
2480||Certificate of Post-Graduate Training|
1921||Certificate of Professional Education|
2829||Malpractice Suits or Claims Form (if applicable)|
3085||Application for Predetermination|
2252||Convictions and Pending Charges|
3071||Fax Payment Form|
|2700||Podiatrist Malpractice Liability Form (annual notification required)|
Application for Locum Tenens
1915||Application for Locum Tenens Licensed to Practice Podiatric Medicine and Surgery|
Application for Temporary Education License
2153||Application for a Temporary Educational License to Practice Podiatric Medicine and Surgery|
|3208||Temporary Educational License - Affidavit of Hospital Authority
|3024||Application for Renewal of Temporary Educational License|