Follow the steps to complete the form accurately.

1. Click ‘Get Form’ button to access the form and open it in your preferred online format.
2. Begin by providing your name in the 'Name of Applicant' field. Ensure you fill in your last name, first name, and middle name clearly to avoid any discrepancies.
3. Indicate your educational background by checking the appropriate box that states if you are a graduate of a medical board approved perfusion school and if you have applied or taken the ABCP certification exams.
4. Complete the affidavit of supervising licensed perfusionist section. Provide the name of the supervising perfusionist and the effective date for the temporary license. Be accurate with details to ensure a smooth approval process.
5. The supervising licensed perfusionist must sign and provide their title, Wisconsin perfusionist license number, contact information, and the location of practice. It is crucial to make sure these entries are valid and match the current licensing records.
6. Finally, review all entries for accuracy and completeness. Once you are satisfied, save your changes and choose to download, print, or share the form as needed for submission.

Begin completing your documents online now to ensure a successful submission.