Conviction Self-Report
Review the information below if you hold a professional license listed in Wisconsin Statute 440.03 13 b and are convicted of a misdemeanor or felony in Wisconsin or elsewhere. You must self-report this conviction to the Wisconsin DSPS within 48 hours.
AccessGov: 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.
Why & when should you self-report a conviction?
If you hold one of the licenses listed in Wisconsin Statute 440.03 (13) (b) and are convicted of a misdemeanor or felony in Wisconsin or elsewhere, you are required to notify the Wisconsin Department of Safety and Professional Services (DSPS) of the date, place and nature of the conviction. You must notify DSPS within 48 hours (using this form) after a judgment of conviction is issued against you. If you fail to notify DSPS within 48 hours, you could face disciplinary action.
Self-Report a Conviction | 2704 Online Form
Wisconsin Fair Employment Act Disclaimer
The Fair Employment Act (Wisconsin Statute 111.31 and Wisconsin Statute 111.395) generally prohibits discrimination based on a conviction of record unless the circumstances of the conviction substantially relate to the circumstances of a particular job or licensed activity. Therefore, the circumstances of your conviction will be evaluated to determine whether they substantially relate, or do not relate, to the circumstances of the profession for which you are licensed. Should any action be taken against your license, said action would be taken in compliance with the procedural requirements of Wisconsin Administrative Code Chapters SPS 2, 6, or 8.
Contact Wisconsin DSPS
4822 Madison Yards Way
Madison, WI 53705
(608) 266-2112
(877) 617-1565
Go to Seeking Information Main Page