Independent Clinical Supervisor

​Additional Resources

Other Forms

Statutes and Administrative Code

Continuing Education Information

Exam Information

Related Links

Orders and Disciplinary Actions

Conviction Self Report

Professional Assistance Procedure

Monitoring

File a Complaint

License Information

Per Wis. Stat. § 440.08 (2), the required renewal date for the Independent Clinical Supervisor credential is 02/28/odd years.  Should you receive your initial credential in the months leading up to this date, you are still required to renew your license by the statutorily defined date.

Requirements

  • Must hold a current certification as a Clinical Substance Abuse Counselor  OR  a Professional Counselor, Marriage and Family Therapist or Social Worker holding a credential under ch. 457, Stats., with the specialty authorization of s. MPSW 1.09. 
  • Attain 10,000 hours of counseling experience within a period of no less than 5 years.
    • Verification of completion of 2,000 hours of patient counseling experience performing the 8 practice dimensions as a clinical substance abuse counselor, supervised by an individual defined in s. RL 162.02(1), within 5 years immediately preceding the date of application. The 2,000 hours shall include 200 hours in direct, face-to-face substance abuse patient counseling. Experience in excess of 40 hours per week or 2,000 hours per year will not be accepted.
    • The hours referred to in this section shall include 200 hours in direct, face-to-face substance abuse patient counseling.
    • Educational equivalencies – intermediate clinical supervisor. Successful completion of education resulting in a degree in a behavioral science field with an addiction emphasis or concentration from an accredited program shall be used to satisfy, in part, the experience requirement. The possession of the following degrees shall be exchanged for experience at the following rate:
      • An associate degree will equal 1,000 hours of supervised experience.
      • A bachelor degree will equal 2,000 hours of supervised experience.
      • A master or doctoral degree will equal 4,000 hours of supervised experience.  
  • Verification of 30 hours of classroom training in clinical supervision. This shall include a minimum of 6 hours of training in each of the following domains:
    • Assessment or evaluation.
    • Counselor development.
    • Management or administration.
    • Professional responsibility.
  • Clinical supervisory experience.
    • Verification of two years of clinical supervisory experience as the supervisor of counselors certified under RL 161 or under s. MPSW 1.09.
    • This experience shall be supervised by an intermediate clinical supervisor, an independent clinical supervisor, a physician, or a psychologist who practices as a substance abuse clinical supervisor within the scope of his or her license.
    • This shall include the provision of 200 contact hours of face-to-face clinical supervision.

Application for Licensure

FormDescription
2744Application for Clinical Supervisor
​2777​Affidavit Regarding Supervised Counseling Experience
​2778​Affidavit Regarding Supervisory Experience
2776Education and Training Form
​2868​ICRC Exam Registration Instructions
​2786Application ​for Reciprocity for Out-of-State Counselors, Supervisors and Prevention Specialists
2829Malpractice Suits or Claims Form (if applicable)
2252​Convictions and Pending Charges
3071​Fax Payment Form

Renewal Information

Requirements

  • FEE (See Renewal Dates and Fees)
  • SIG (Signature regarding the completion of Continuing Education in Chapter SPS 165.01, included in online renewal and paper form - see Continuing Education Information for details)
  • If your legal status as a qualified alien or nonimmigrant lawfully present in the United States has changed since the issuance of your credential or your last renewal, please contact the Wisconsin Department of Safety and Professional Services at (608) 266-2112 or dsps@wisconsin.gov.

Renewal Methods

  • Online Log In: License Renewal Online
  • Request a Paper Renewal Form: (888) 506‑4239 or (608) 261‑4460 for the Madison area
FormDescription
RDAFRenewal Dates and Fees
R210Active Duty/Discharge Renewal Extension

Wisconsin Act 210 (effective June 1, 2012)

This Act extends the license of a service member if the license expires while they are on active duty from 90 days to 180 days from the date of discharge. The same applies to a spouse of a service member if the spouse does not practice under their license while the service member is on active duty and does not practice because the service member is on active duty.

This Act repeals a provision of prior law that required a service member to meet all of the requirements for license extension or renewal, except for continuing education requirements, in order to have the license extended.

Service members and spouses may request extensions of licenses beyond 180 days from discharge and may request a waiver or extension of time to complete continuing education requirements due to hardship. Please view Active Duty/Discharge Renewal Extension Form #R210.