Chapter 1 Application to License Agents

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

Name of Institution: *

Name of Administrator: *

Phone Number of Administrator: *

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: *

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

Add Remove

To add another staff member, please hit the "Add" button above prior to hitting submit.

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