Intermediate Clinical Supervisor

License Information

Per Wisconsin State Statutes 440.08 (2), the required renewal date for the Intermediate 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 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 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

FormDescription
2744Application for Clinical Supervisor
​2778​Affidavit Regarding Supervisory Experience
2776

Education and Training Form
2829

Malpractice 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 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.