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
:
05/06/2008
Application#
:
308276
Name
:
HACKER, CALLENDA A
Profession
:
Temporary Education Training Permit
Address
:
Lubbock, TX
Application Status
:
(Temporary permit 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 Applicable blanks completed
Met
Application Fee
Met
$
All activities and practice accounted for from the date of graduation to the present. Provide hospital name, location (city&state) and beginning and ending dates (month&year)
Met
PAGES 2 & 3 All questions answered and relevant copies attached
Met
PAGE 4 Affidavit of applicant, signed and notarized
Met
PAGE 5 Affidavit of hospital authority
Met
DOCUMENTS REQUIRED Addendum to Application (Form #2380)
Met
Professional Diploma (photocopy)
Met
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