Chapter 1 Application to License Agents

A $100 fee will be assessed for each licensed agent.

Name of Institution: *

Verified ACH Payment

Name of Administrator: *

Phone Number of Administrator: *

Mailing address where agent cards should be sent: *

Mailing address where agent cards should be sent:

City

State/Province

Zip/Postal

Country

Registration Period (July 1 through June 30 annually): *

Agent Information:

Registered Agent Name: *

Address: *

Address:

City

State/Province

Zip/Postal

Country

Phone Number

Institution has carefully reviewed the qualifications and the personal data of the above applicant and believes that he/she will perform as pledged above. *

Yes

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PAYMENT INFORMATION:

Preferred Method of Payment *

Number of agents being licensed today *

Please submit checks payable to the Wyoming Department of Education to the following address:

Wyoming Department of Education 
Attn:  Elaine Marces
2300 Capitol Ave.
Hathaway Building 2nd Floor
Cheyenne, WY 82002
For questions please call:
307-777-6210

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