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Application Instructions for a Provisional License as a Student Midwife

Specific requirements are detailed in the Rules and Regulations which are published on the Board’s web page.
Please review the requirements prior to submitting an application.

GENERAL INFORMATION
  • In compliance with U.S. Code Title 8, Chapter 14, Section 1621, the Board must collect proof of U.S. citizenship, or proof of legal presence in the U.S. This proof is required only once for each U.S. citizen. Those with alien status will be required to submit proof with every renewal. In most cases it is easiest for you to provide us with a copy of your birth certificate, copy of your social security card or a copy of your passport. Just one (1) form of identification is required. A copy of your driver’s license is not acceptable. If you cannot provide any of these items, please refer to list A and B.
  • The Board cannot review your qualifications without receipt of an application and fee.
  • Incomplete applications will not be reviewed.
  • The application fee is $400.00. Make checks payable to the "State of Wyoming". Do not send cash. All fees are non-refundable regardless of the outcome.
  • Every effort will be made to review your application within two (2) to five (5) business days of completion.
  • MEAC stands for the Midwifery Education Accreditation Council.
LICENSE REQUIREMENTS

To qualify for licensure for a Provisional License as a Student Midwife in Wyoming you must meet the following requirements:
  • be a legal inhabitant of the United States, and
  • have a high school diploma or equivalent, and
  • have not been convicted of a crime which in the judgment of the Board renders the person unfit to practice midwifery, and
  • have not provided materially false or misleading information to the board, and
  • is undertaking the practicum required by the Board, and
  • agrees to practice midwifery only under the supervision of another Wyoming licensed midwife, a Wyoming licensed certified nurse midwife, or a person licensed under the Medical Practice Act.
APPLICATION PROCEDURES

  1. Every applicant must provide a set of completed fingerprint cards necessary for a criminal history record background check. Contact the Board at 307-777-3628 or e-mail Emily.Cronbaugh@wyo.gov and request that we mail you a set of cards. The cards will come with instructions on how to submit them to the Board for processing.
  2. Complete the application in its entirety. Make sure that you provide a written explanation if you answered "YES" to any of questions 14 through 22. If more space is needed, attach additional sheets of paper. You must include copies of all legal documents. Read the "Warning" and "Agreement and Affidavit", print the form, and then sign and date the application, preferably with blue ink. The Board is not able to accept electronic signatures and payment at this time.
  3. Request that director or registrar of your MEAC accredited program send the Board a letter verifying your enrollment in the program and that you are undertaking the required practicum. The verification letter must be sent directly to the Board office. It can be sent via email to Emily.Cronbaugh@wyo.gov via fax to (307) 777-3508 or via mail to the Board at the address provided below.
  4. Mail the complete application (2 pages), proof of U.S. citizenship or legal presence in the United States, completed fingerprint cards and the $400.00 application fee, to the Board at the address provided below.
PROCESS

If you have provided a valid e-mail address on your application, you will receive a confirmation message when your application, proof of U.S. citizenship or legal presence in the United States, and fee are received. When the remaining required documents are received your application will be reviewed for provisional license approval. If your application is approved you will receive a confirmation letter, a copy of the approved supervision agreement, a pocket identification card, and a receipt.

Inquiries regarding these application procedures and application status may be directed to:

Wyoming Board of Midwifery
2001 Capitol Ave, Room 104
Cheyenne WY 82002
(307) 777-3628

Emily Cronbaugh, Licensing Specialist, Emily.Cronbaugh@wyo.gov

or

Michelle Lamorie, Executive Director, Michelle.Lamorie@wyo.gov

Forms:

Application for Licensure
List A & B
Supervision Agreement