Please ensure you use the newest renewal form (04/01/2021). Each provider type has a different application, so if you have more than one provider type, additional emails are being sent. All renewal applications are also posted on our website at: https://health.wyo.gov/aging/hls/
Payment is still required to be in the form of a check payable to: Treasurer, State of Wyoming. Since no paperwork is required to be mailed in, please ensure the facility name listed in #1 of the application is clearly identified somewhere on the check, in order for payment to be credited to the proper facility. Each renewal application requires a separate check.
Renewal applications need to be submitted by Email. Hard copies are NOT needed. When Emailing please use the following subject line: License Renewal – [List your facility name and type of facility here]
Renewal applications can be signed by the Administrator/Director, CEO, CFO or an Owner. Submission of an original signature page is NOT needed.
New licenses will be emailed out no later than the week of June 21, 2021, if not sooner.
For further questions regarding the renewal application process, contact HLS by sending a detailed email (include facility name and facility type) to: firstname.lastname@example.org or email@example.com
SUBMISSION DEADLINE: Renewal application and fee must be received no later than May 24, 2021.
Click the appropriate application below to download and save: