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  :  10/26/2007
Application#  :  291364
Name  :  Fair, Otha K
Profession  :  Substance Abuse Counselor-in-Training
Address  :  RACINE, WI
Application Status  :  Withdrawn (Abandoned)


Requirements Not Met:
Description Status Comments (Please note, not all requirements will include comments)
Education and Training Form including proof of attendance and completion Not Met
Rec'd page 1 of education form. Waiting for page 2 of education form, proof of completion, and course descriptions.

Requirements Met:
Description Status Comments (Please note, not all requirements will include comments)
Application Fee Met
3/26/13
Application withdrawn and marked as "abandoned" due to inactivity for more than one year. $
Wisconsin Statutes and Rules Exam Met
Passed
PAGE 1 Applicable blanks completed Met
PAGES 2 & 3 All questions answered and relevant copies attached Met
PAGE 4 Affidavit of applicant, signed and notarized Met
Social Security Number Met
Employment Verification Form #127 Met