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    Application Packet

Dietetics Application

Individual Forms

Verification of License from Wyoming
Change of Name or Address
Roster Request
Replacement Document Request

Renewal Form

Your license to practice as an dietitian in Wyoming will expire on June 15, 2015. If not renewed, your license shall be considered lapsed and you may no longer legally practice as an dietitian in the state of Wyoming.

The complete renewal application must be POSTMARKED no later than June 15, 2015 in order to meet the renewal deadline. Any renewals postmarked after June 15, 2015 and prior to June 30, 2015 will be charged an additional $225.00 late fee.

Renewal Application Form