Intermediate Clinical Supervisor

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Now Live: Easier Online License Applications and ​Renewals!

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​LicensE is your online, self-guided occupational license application platform. 

Please review the helpful links below:

  • Find step-by-step instruction for license renewal here.
  • Find a list of license renewals available via LicensE in the chart on the LicensE Customer Information page.
  • Find all licenses available via LicensE, plus user guides and other resources, on the LicensE Customer Information page.
  • Anyone applying for an initial license for any of the credentials listed can apply at license.wi.gov.

Our LicensE Application Status Lookup tool makes it easier for employees, and helps academic advisors support students during the license application process. To access the Application Status Lookup tool, you will need the applicant's 10-digit PAR number. An applicant may provide the number to anyone who could support their application. Find more information in our news release about this tool. ​​

​​​License Information

Per Wis. Stat. §​ 440.08(2)​, the required renewal date for the Intermediate Clinical Supervisor credential is 02/28/ each odd-numbered year.  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 Wis. Stat. ch. 457​ 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 Wis. Stat. §​ 440.88, or having a license under § 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
2744Credentialing Information for Clinical Supervisor Applicants
​2786Credentialing Information ​for Reciprocity (For Out-of-State Counselors, Supervisors, and Prevention Specialists.)
​3217​Application for Fee Reduction (Optional - If applying for a fee reduction, this form must accompany the LicensE​ application for the credential.)
​2778​Affidavit Regarding Supervisory Experience
2776

Education and Training Form
​3222​Information for Substance Abuse Professional Late Renewal Applicants (For credentials expired five years or more)
2829

Malpractice Suits or Claims Form (If applicable)
​3085​Application for Predetermination (Optional-Submit ONLY if you have been convicted of any felony, misdemeanor, or other violations of federal or state law in this state or any other and you desire a review of your conviction record before applying for a credential.)​
2252

​Convictions and Pending Charges (if applicable)


Renewal Information

Requirements

  • FEE (See Renewal Dates and Fees)
  • SIG (Signature regarding the completion of Continuing Education in Wis. Admin. Code §​ 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 Method​

FormDescription
RDAFRenewal Dates and Fees​
​2254​
​Convictions​ and Pending Charges (if applicable for renewal) 
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.