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  :  08/02/2021
Application#  :  719798
Name  :  ABUSHALANFAH, SAMER M
Profession  :  Massage Therapist or Bodywork Therapist
Address  :  milwaukee, WI
Application Status  :  Withdrawn (Abandoned)


Requirements Not Met:
Description Status Comments (Please note, not all requirements will include comments)
Verification of passing a National Massage Exam Not Met
6/23/21: Proof of passing required. This must come directly from FSMTB. If you have not already made this request the MBLEx Result Transfer Form can be found at following link: https://www.fsmtb.org/mblex/mblex-result-transfer-form/. - jnl

Requirements Met:
Description Status Comments (Please note, not all requirements will include comments)
Wisconsin Statutes & Rules Examination Met
5/13/20: Passed
MS
4/28/20: You may take this exam at any time. Once completed, please allow at least 10 business days for it to be manually updated to your application status. Prior to taking exam, review instructions at:
https://dsps.wi.gov/Pages/Professions/MassageTherapistBodyworkTherapist/Exams.aspx
When at ParTest Online you’ll need the following:
Test Name: MTB12B
Test Password: MTB12B
Student ID: 719798
Application Complete Met
Rec'd. KC
04/28/20: Need SSN. Please update and send it to DSPSCREDMEDBDAffiliates@wisconsin.gov
AD
Application Fee Met
$150
Massage Therapy or Bodywork Therapy Program (form #2962) Met
Center of Moqableen (Jordan)
6/23/21
Official Transcript(s) Met
6/23/21:
AED/CPR Certification Met
Expires 10/2021
AD
Malpractice Insurance Met
Exp. 12.31.2021
kjc
10/23/20 Rec'd business insurance. Need proof of professional liability insurance for massage therapy activities. - jnl
8/31/20: Need copy of Certificate of Insurance (not membership certificate/card or proof of membership; this page usually states ‘Certificate of Insurance’ on it). Legible copy can be faxed to 608-251-3036 or emailed to DSPSCREDMedBdAffiliates@wi.gov. KC
Verification of other state license(s) and/or credential(s) Met
Rec'd Jordan/Amman - jnl
6/30/20: Rec’d verification from applicant. Verification of licenses must be sent directly from state board to state board, they can be submitted via email to DSPSCREDMedBdAffiliates@wi.gov or faxed to 608-251-3036. KC
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Please contact Jordan and have them send us your license verification to DSPS.