Application Status Query

Instructions: 

Please allow one hour after receipt of your status update email for the updates to be reflected in the online checklist.

Please verify the checklist information below, including your address. If your address has changed, please e-mail your application number, name, profession, along with your old and new address. The Credentialing department posts status information following receipt and review of application materials.

As of  :  03/23/2004
Application#  :  189299
Name  :  O'Brien, Neil F
Profession  :  Physical Therapist Assistant
Address  :  Brown Deer, WI
Application Status  :  (Permanent license issued)


Requirements Not Met:
Description Status Comments (Please note, not all requirements will include comments)

Requirements Met:
Description Status Comments (Please note, not all requirements will include comments)
PAGE 1 Wisconsin Statutes & Rules Examination Booklet and answer sheet Met
PASSED
Applicable blanks completed Met
Application Fee Met
PAID 12/19/03 $
PAGE 2 All activities & practice accounted for from date of graduation to present. Provide employers name, location (city&state), dates (month&year), # of hours worked per week, job title & duties Met
PAGE 2, 3 & 4 All questions answered and relevant copies attached Met
PAGE 4 Affidavit of applicant, signed and notarized Met
PAGE 5 Social Security Number Met
FOLLOWING DOCUMENTS REQUIRED Professional Diploma (photocopy) Met
Certificate of professional education (Form #3196) Met
Graduated 12/95
NPTE score transfer results received from FSBPT Met
2 letters of recommendation