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  :  11/18/2021
Application#  :  740253
Name  :  Kempel, Samantha J
Profession  :  Dental Hygiene
Address  :  Kent, IL
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)
Application Complete Met
01/11/2021 : Rec'd

-MS
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11/11/2020 : Applicant applied by exam but needs to apply by endorsement because graduation date is not within 5 years from today. Applicant can email dspscreddentistry@wi.gov requesting to change application method to endorsement.
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Also, applicant did not include city in address. This information can be emailed to dspscreddentistry@wi.gov

//MS
Application Fee Met
$149
Wisconsin Statutes & Rules Examination Met
10/7/2021: Complete
/KS
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11/11/2020:
You may take this exam at any time. Before you start the exam review the instructions by copying and pasting the following URL into your browser: https://dsps.wi.gov/Pages/Professions/DentalHygienist/Exams.aspx.
Please copy and paste the Exam Website URL into an INTERNET EXPLORER browser: http://eptol.drl.wi.gov/.
Passing score is 85%.
When you're at the ParTest Online you will need the following info:
Instructor: gsp
Test Name: DHY11A (case sensitive)
Test Password: DHY11A (case sensitive)
Student ID: Your DSPS Application ID Number
Copy and paste this URL into your web browser to view the Related Code and Statutes: https://dsps.wi.gov/Pages/RulesStatutes/DE.aspx

//MS
Is name on all credentials the same? If not, submit copy of marriage certificate, divorce decree, etc. Met
Certificate of Professional Education (Form #1463) (including signature and school seal) Met
2/12/2021: Rec'd
/KS
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11/11/2020: NEED: Form # 1463 from your school. If you have not already done so, download Form # 1463 from our website (http://dsps.wi.gov), complete your portion and send to your school. Your school must complete the form and mail it directly to us at: DSPS, ATTN: DENTISTRY EXAMINING BOARD, P.O. BOX 8935, MADISON, WI 53708-8935. Transcripts are not accepted in lieu of this requirement. Please allow 7-10 business days for processing once received here in the Department.

//MS
Regional Dental Testing Service Score Card(s) (Original(s) pass & fail) CRDTS, NERB or WREB Met
2/12/2021: Rec'd
/KS
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11/11/2020: NEED: Original score reports (both pass and fail) directly from testing agency. Score reports from the applicant, photocopies and faxes are NOT acceptable. If you have not already done so, please request your scores from the testing service. For your National Dental Hygiene Examination score report, please contact the ADA. You will need a DENTPIN in order to authenticate your request. Search for your DENTPIN here: http://dts.ada.org/CustomerServices_ADA/RetrieveDENTPIN.aspx?transaction=DAT. Or call the agency at – (312) 440-2500. Regional exam contact information will vary depending on which exam you took. If you need assistance finding contact information for a regional testing service, please call us at: 608-266-2112. The testing service should mail your scores directly to: DSPS, ATTN: DENTISTRY EXAMINING BOARD, P.O. BOX 8935, MADISON, WI 53708-8935.

//MS
National Board Score Card(s) (Original(s) pass & fail) Met
2/12/2021: Rec'd
/KS
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11/11/2020 : Go to ADA website: www.ada.org/dentpin to request your results to be sent to WI. You will also need to pay a $36.00 fee for this. Results will be uploaded within a business day. Please send email to let us know that this has been done so that we may pull your score & update your application accordingly. DSPSCREDDENTISTRY@WI.GOV

//MS
Clinical and laboratory examination scores from old state board exam and copy of state law in effect at credentialing Met
AED/CPR Certification Met
Verification of other state license(s) and/or credential(s) Met
2/12/2021: Rec'd
/KS
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11/11/2020: NEED: IL-- If you have not done so, please request licensure verification from IL. Verification should include the following: 1) license number; 2) licensed profession; 3) original date of issuance; 4) current license status; 5) statement regarding disciplinary actions. Online verifications, photocopies and license verifications submitted by the applicant are not acceptable. States/Countries must mail licensure verifications directly to: DSPS, ATTN: WI DENTISTRY EXAMINING BOARD, P.O. BOX 8935 MADISON, WI 53708-8935

//MS
Board Approval (This file has been sent for approval of licensure). Met
11/17/2021: Information received from applicant. File sent to liaison.-CL

10/7/2021: File sent to board liaison for final review. Once a response is received, checklist will be updated.
/KS
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11/11/2020 : Once all other requirements are met application will be sent to board liaison for review.

//MS