Application to License an Agent
A $100 fee will be assessed for each licensed agent.
Check Number or ACH Date
Name of Institution
Agent(s) are representing the following:
Chapter 1 Non-Degree Granting Proprietary School
Chapter 18 Non-Religious K-12 School
Chapter 30 Degree Granting Institution
Name of Administrator
Administrator Phone Number
Please enter a valid phone number.
Mailing address where agent cards should be sent
Street Address Line 2
State / Province
Postal / Zip Code
Registration Period (July 1 through June 30 annually)
By accepting the terms, the institution agrees the the qualifications and personal data of the applicant have been vetted and believes that he/she will represent the institution as pledged.
A $100 fee is required for each application agent. Checks should be sent to: Wyoming Department of Education Attn: Elaine Marces 122 W. 25th St. Suite E200 Cheyenne, WY 82002
Number of agents being registered today
Fee per agent
Total Amount Due
Should be Empty: