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  :  09/29/2021
Application#  :  778333
Name  :  Edmonds, Jaclyn A
Profession  :  Nurse - Midwife
Address  :  Eau Claire, WI
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
9/16/21: Your application has been reviewed. This item will remain unmet until all other requirements are met. ----KG
Application Fee Met
9/29/21: rec'd - MG
9/29/21: The payment information you provided was unable to be processed. Please resubmit payment using the Fax Payment Form (form 3071) which can be found at www.dsps.wi.gov, and fax to 608-251-3036 or email to DSPSRenewal@wisconsin.gov. Be sure to include your application number and profession in the space provided on the Fax Payment Form. Payment by check can be mailed to: DSPS, PO Box 8935, Madison, WI 53708-8935. Please include your application number on the check. ---- MG
9/22/21: The payment information you provided was unable to be processed. Please resubmit payment using the Fax Payment Form (form 3071) which can be found at www.dsps.wi.gov, and fax to 608-251-3036 or email to DSPSRenewal@wisconsin.gov. Be sure to include your application number and profession in the space provided on the Fax Payment Form. Payment by check can be mailed to: DSPS, PO Box 8935, Madison, WI 53708-8935. Please include your application number on the check. ---- MG
09/16/21: $57.00 application fee needed. If you have not already submitted fees separately from the application, please print a copy of this page and return with $57.00 payment to DSPS, PO BOX 8935, MADISON WI 53708-8935; OR you may fax credit card payment using the Fax Payment Form available at https://dsps.wi.gov/Credentialing/General/fm3071.pdf -------- KG $57
Holds a current WI RN license in good standing Met
WI RN--KG
Certification of Nurse Mid-Wifery Degree from your school. (form #2551) Met
9/28/21: Received. --- EOY
9/16/21: Please have your graduating school submit form #2551 directly to our department (on or after the date of graduation); fully completed with date completed given on form. This needs to be submitted to us directly form the school. School may email form directly to DSPSCredNursing@wi.gov or fax with official school fax cover letter to608-251-3036; Attn: Nursing
------------------ KG
Certification form for NMW's who do not carry Personal Liability Insurance coverage (form # 2610) Met
09/16/21: Received--KG
Verification of Certification from American Midwifery Certification Board Met
09/16/21: Received--KG