NOTE: Please do not use this system for renewing your nurse aide certification in Wisconsin. For assistance with renewal, contact the Wisconsin Department of Health Services at
DHSWIDQA_NATCEP@dhs.wisconsin.gov DO NOT COMPLETE THIS FORM if you have ever been listed on the Wisconsin Nurse Aide Registry. Check for your certification status on the Wisconsin NA Registry at
https://wi.tmutest.com/ Please read these directions before you complete and submit this form. Your request for reciprocity cannot be processed if it is incomplete, illegible, or includes false statements.
TRAINING: You must have completed a (minimum) 75-hour state-approved nurse aide training program (with the date of completion noted) to be considered for the Wisconsin Nurse Aide Registry. State registry printouts and certificates that do not provide training program names or dates of completion are not acceptable. [Wis. Admin. Code DHS 129.09(5)(b); Wis.Stat. § 146.40(2)(d); (2g)(a),(b)]
Acceptable proof of training includes: - A copy of your diploma or transcripts from your training program (with date of completion),
- Or a letter from the training program stating where and when you completed the training
If you are unable to provide proof of training, you may instead include proof of qualifying employment:Your employer(s) must verify you worked as a nurse aide under the direction of a registered nurse (RN) or licensed practical nurse (LPN) for at least 2,088 hours in the two years preceding your application to the Wisconsin Nurse Aide Registry.
Please use the employer verification form 9110WI-A. Click
here for the 9110WI-A. If you worked in multiple facilities/locations, you may complete more than one employment verification form 9110WI-A.
Please upload all employment verification forms (9110WI-A) with this application. ALABAMA APPLICANTS: If you originally trained in Alabama more than two years ago and are only certified in Alabama, you must also include employment verification that you worked as a nurse aide under the direction of an RN/LPN during the previous two years.
Please use the employer verification form 9110WI-A. Click
here for the 9110WI-A form. Complete this form, 9110WI. Attach required training and identification documents. Pay the non-refundable reciprocity verification and processing administrative assessment fee of $25 through the secure credit card processing portal.
Please note: Completing this form requires the following attachments: - Proof of Training and/or Employment Verification (using Form 9110WI-A)
- Image of your social security card
- Image of your valid US government-issued photo identification (state driver’s license, passport, or other signed current, photo identification).
Your application is not complete until the required information is included, then select “Send Application.”