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.
Pursuant to 2017 Wisconsin Act 262, as of May 1, 2018, the requirements to obtain an Independent Clinical Supervisor credential have changed.
Requirements
- Must hold a current certification as a Clinical Substance Abuse Counselor, Intermediate Clinical Supervisor OR a Professional Counselor, Marriage and Family Therapist or Licensed Clinical Social Worker holding a credential under ch. 457, Stats., at the master's level or higher, OR hold an American Association for Marriage and Family Therapy Supervisor Certification.
- Provide evidence of at least one year of clinical supervisory experience as a supervisor in-training or intermediate clinical supervisor within the last 5 years as the supervisor of counselors certified under s. 440.88 stats., or having a license under s. 5.457.08(4), 457.10, 457.11, 457.12, 457.13, or 457.14(1)(d) to (f).
- Successful Completion of 30 hours of clinical supervision to included a minimum of 6 hours of training in assessment and evaluation, counselor development, management and administration, and professional responsibility.
- Pass the National Association of Alcoholism Counselors and Trainers NCSE exam.
Application for Licensure
| Form | Description |
|---|
| 2744 | Application for Clinical Supervisor |
| 2778 | Affidavit Regarding Supervisory Experience |
| 2776 | Education and Training Form |
| 2786 | Application for Reciprocity for Out-of-State Counselors, Supervisors and Prevention Specialists |
| 2829 | Malpractice Suits or Claims Form (if applicable) |
| 2252 | Convictions and Pending Charges |
| 3071 | Fax Payment Form |
