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We are transitioning our forms to an online platform, AccessGov, that meets Americans with Disabilities Act (ADA) guidance. You will be able to submit some forms directly within the platform, while some may require you to print to PDF and upload to another system. Please follow the instructions on each form to ensure proper submission.

​If you hold one of the credentials listed in Wis. Stat. § 440.03(13)(b) and are convicted of a misdemeanor or felony in this state or elsewhere, you are required to notify the Department in writing of the date, place and nature of the conviction within 48 hours after the entry of the judgment of conviction. Failure to submit notification could result in disciplinary action against your license.

Report a Conviction (Form 2704DLSC) 

The Fair Employment Act (Wis. Stat. §§ 111.31 and 111.395) generally prohibits discrimination on the basis of conviction record unless the circumstances of the conviction substantially relate to the circumstances of the particular job or licensed activity. The circumstances of your conviction will be evaluated to determine whether they substantially relate to the circumstances of the profession for which you are licensed. No action will be taken against your license without compliance with the procedural requirements of Wis. Admin. Code chs. SPS 2, 6, or 8.