Predetermination
Pursuant to
2017 Wisconsin Act 278, beginning August 1, 2018, prior to submitting an application for a credential, an individual may apply to the Department for a determination of whether the individual would be disqualified from obtaining the credential due to his or her conviction record. To apply for a predetermination, please fill out
Form #3085 and submit all required documentation specified on the form. Pursuant to
Wis. Stat. §
111.335(4)(e), the offenses or kinds of offenses that may result in a refusal, bar, or termination of licensure are published under Additional Resources on the left side of this page.
License Information
Fee Reduction
Pursuant to 2017 Wisconsin Act 319, beginning August 1, 2018, an applicant for an initial credential may apply for a reduction of the initial credential fee that is equal to 10% of the initial fee. Qualification is based on the federal adjusted gross income being at or below 180% of the federal poverty guideline prescribed for the applicant's family household size by the United States Department of Health and Human Services. To determine eligibility please visit the United States Department of Health and Human Services website at https://aspe.hhs.gov/poverty-guidelines, prior to submitting Form 3217.
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 |
| 3217 | Application for Fee Reduction (If applying for a fee reduction, this form must accompany the application for the credential.) |
|
2778 | Affidavit Regarding Supervisory Experience |
|
2776 | Education and Training Form |
|
2786 | Application for Reciprocity for Out-of-State Counselors, Supervisors and Prevention Specialists |
| 3222 | Re-Registration Application for Substance Abuse Professionals (For credentials expired five (5) years or more) |
|
2829 | Malpractice Suits or Claims Form (if applicable) |
|
3085 | Application for Predetermination (Submit ONLY if you have been convicted of any felony, misdemeanor, or other violations of federal, state, or local law, including municipal ordinances, in this state or any other) |
|
2252 | Convictions and Pending Charges |
|
3071 | Fax Payment Form |