Get Fm2124.doc - Dsps Wi

This guide provides a detailed walkthrough for completing the Fm2124.doc - Dsps Wi, an application form essential for certification as an advanced practice nurse prescriber in Wisconsin. By following these steps, users can ensure that they fill out the form accurately and efficiently.

Follow the steps to complete the application form online.

1. Press the ‘Get Form’ button to access the document and open it in your preferred editor.
2. Begin by entering your last name, first name, and middle initial in the designated fields.
3. If applicable, provide your former or maiden names.
4. Fill in your street address accurately, including city, state, and zip code. If you have a different mailing address, include that information as well.
5. Enter your date of birth in the specified format: month, day, and year.
6. Provide your daytime telephone number for contact purposes.
7. Optional: Indicate your sex and ethnic status in the provided checkboxes.
8. Specify if you have ever held a license or credential in the state of Wisconsin, and if so, provide your Wisconsin license or credential number.
9. List your nursing school, including the full address and the date of your diploma.
10. Make sure to include the application fees, attaching a check payable to DSPS.
11. Indicate your primary state of residence, and clarify whether you plan to move to Wisconsin.
12. Ensure that all required documentation, such as malpractice insurance and verification of national certification, is attached as per the requirements outlined.
13. Proceed to complete any additional certifications and answers related to your current licenses and insurance.
14. Review your responses thoroughly for accuracy.
15. Save changes to the document, and choose to download, print, or share the form as needed.

Complete your application and submit it online to expedite the certification process.