Wv dhhr form ew 212 2026

1. Click ‘Get Form’ to open the wv dhhr form ew 212 in the editor.
2. Begin by entering the Application Date and Date of Birth in the specified fields. Ensure these are formatted as mm/dd/yy.
3. Fill in your First Name, Last Name, Middle Initial, and Suffix. Provide your Home Phone number and complete your Home Address, including City, State, Zip, and County.
4. Indicate if this is a new address by selecting 'Yes' or 'No'. Remember, this address will be used for mailing certification information.
5. Enter your Certification Number and Email address. Also, provide the Certification Expiration Date.
6. Select the type of certification you wish to renew by checking the appropriate box. Be mindful of any associated fees.
7. List course information below and attach copies of completion certificates. If more space is needed, add additional information as necessary.
8. Finally, review all entered information for accuracy before signing and dating the form at the bottom.

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