Physician Assistant - Forms
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You will need to choose one of the application packet(s) listed below. Every form in the packet that you choose must be submitted if it applies to your situation.
Petitions for refunds must be in writing and may be granted only if the criteria set forth in Wis. Admin. Code s. RL 4.06 are met.
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Physician Assistant Application Packet
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Form # |
Title
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Physician Assistant Credentialing Information |
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Application for Licensure as a Physician Assistant
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Physician Assistant Certificate of Professional Education (This
form must come directly from the school) |
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Request for Temporary License for Physician Assistant (for
exam applicants only) |
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Request for National Examination Scores (This form must
be forwarded to NCCPA) |
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Addendum to Application (Required, social security number) |
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Convictions and Pending Charges |
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Wisconsin Statutes and Rules open book exam (Required to
take the online exam) |
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Notice (Department Information) |
Physician Assistant Re-Registration Application Packet
(If you have held a license in WI but it has been expired 5 years or more, then you will need to re-register)
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Title
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Application for Re-Registration of Licensure
as a Physician Assistant |
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Addendum to Application (required, social security number) |
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Wisconsin Statutes and Rules open book exam (required to
take the online exam) |
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Convictions and Pending Charges |
Other Information / Forms
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Title
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Change in Supervising Physician Form |
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Physician Requirements and Guidelines |
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The Amphetamine Rule |
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Disability Modification Request Form for Examinations |
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Professional Verification of Request For Modification |
Last updated:
Monday, February 2, 2009
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