Wisconsin Department of Safety and Professional Services
Health & Business Renewal Application
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
:
08/12/2008
Application#
:
306459
Name
:
VAN HEEL, RACHEL T
Profession
:
Physical Therapist
Address
:
MAPLEWOOD, MN
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 4/11/08 $
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
Request for Temporary License (Form #3197)
Met
paid 4/11/08
temp lic#11018
valid from 6/3/08
expires 9/3/08
NPTE exam registration form and fee (Must register online with FSBPT at https://pt.fsbpt.net)
Met
NPTE approval forwarded to FSBPT
Met
NPTE results from FSBPT
Met
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