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  :  02/04/1999
Application#  :  36969
Name  :  D'Urso, JENNIFER EISENMANN
Profession  :  Physical Therapist
Address  :  Cedarburg, WI
Application Status  :  (Permanent license issued)


Requirements Not Met:
Description Status Comments (Please note, not all requirements will include comments)
Is name on all credentials the same? If not, submit copy of marriage certificate, divorce decree, etc. Not Met
Application Fee Not Met
Page One - Applicable blanks completed Not Met
All activities and practice accounted for from the date of graduation to the present. Provide employers name, location (city&state), dates (month&year), # of hours worked per week, job title & duties Not Met
Page Two - Applicable blanks completed Not Met
All questions answered and relevant copies attached Not Met
Affidavit of applicant, signed Not Met
Photograph Not Met
National Physical Therapy Examination Scores Not Met
Certificate of secretary of State Board issuing original original license (Form #1360) (directly from state board) Not Met
Professional Diploma Not Met
Certificate of Professional Education (Form #3196) Not Met
Request for Temporary License (Form #3197) Not Met
Copies of court or insurance documents of all malpractice suit(s) Not Met
Evaluation completed from foreign graduate evaluation service Not Met
Official Score Report from TOEFL / Notarized Copy of CGFNS Certificate Not Met
Verification of other state license(s) and/or credential(s) Not Met

Requirements Met:
Description Status Comments (Please note, not all requirements will include comments)
Wisconsin Statutes & Rules Examination Met