State of Wisconsin Department of Regulation & Licensing
Ensuring the availability of safe and competent professional services 		Secretary Celia Jackson
 Secretary Jackson
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Marriage and Family Therapy, Professional Counseling and Social Work Examining Board- Application Forms

You will need to choose one of the application packet(s) listed below. Every form in the packet that you choose must be submitted if it applies to your situation.

Petitions for refunds must be in writing and may be granted only if the criteria set forth in Wis. Admin. Code s. RL 4.06 are met.


Substance Abuse Specialty Authorization Forms
Form #
Title
Application for Substance Abuse Specialty Authorization
Affidavit Regarding Supervised Experience for Substance Abuse Specialty Authorization
Substance Abuse Specialty Authorization Education and Training Pharmacology form
Substance Abuse Specialty Authorization Education and Training form
Department approved pre-certification programs for substance abuse education. (Additional programs will be added as programs are submitted and approved.  *NOTE* If you completed one of the approved programs, you may submit an official transcript in lieu of the Education and Training forms.)