Wis. Stats. Chapter 45	2135 Rimrock Road, P.O. Box 7843, Madison, WI 53707-7843 (608) 266-1311 | 1-800-WIS-VETS (947-8387)
ELIGIBILITY APPLICATION PROFESSIONAL/OCCUPATIONAL LICENSURE FEE WAIVER
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04(1)(m)].
The provision of your social security number is voluntary. Failure to provide your social security number may result in an information processing delay.

Completion of this application will result in the generation of an eligibility code for a professional/occupational licensure fee waiver, assuming all eligibility criteria are met. This code will be provided to you and will be verifiable, through this agency, by any professional or occupational license granting entity listed in s.45.44, Stats.

Please Provide Supporting Documentation Required — Check which item you are submitting.
National Guard and/or Reserves: Discharge Document or Commander’s Letter (see sample on reverse side)
Other Service: Discharge Document
Please Provide Proof of Residency such as: Failure to provide residency documentation may result in a Fee Waiver delay.
State voting record
County voting record
Wisconsin driver’s license
Wisconsin income taxes
Form DOD 2058, State of Legal Residence
Wisconsin resident hunting license
Wisconsin resident fishing license
Municipal voting record
Proof of residency for instate tuition purposes at a University of Wisconsin or Wisconsin Technical College Institution
Form WDVA 0005, Notarized Residence Affidavit
Veteran’s Name:
First	Middle	Last
Veteran’s Phone Number:
Veteran’s Address:
Street	City, State, Zip
Update my address on file with the above address.
Veteran’s Social Security Number:	(Social Security Number provides faster response time.)
How do you want to receive your eligibility code?
Send To Above Address
Send To This Email Address
(Faster response is by email.)
Under penalties of law, I declare that the above information is true, correct and complete, to the best of my knowledge.
Veteran’s Signature	Date

SAMPLE COMMANDER’S LETTER

Unit Name

Unit Address

Unit Contact Info

Date

Memorandum for Record

Subject:	Wisconsin Veterans Professional/Occupational Licensure Fee Waiver Program

Honorable Service Verification

{Rank, Name of Service Member} has served honorably while assigned to this unit since {begin date}.

Respectfully,

Commander’s Signature Block