State of Wisconsin Department of Regulation & Licensing
Ensuring the availability of safe and competent professional services 		Secretary Celia Jackson
 Secretary Jackson
Home | About DRL | Site Map | Contact DRL | Request PIN | Health Professions | Business Professions | All Boards
 
Download Help
Practice FAQs

Obtain License
 

Independent Clinical Supervisor - Forms

(formerly Certified Clinical Supervisor II)

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.
Application for Original Certification
Form #
Title
Instructions for Independent Clinical Supervisor Application
Application for Independent Clinical Supervisor
Affidavit Regarding Supervised Counseling Experience
Affidavit Regarding Supervisory Experience
Education and Training Form
Convictions and Pending Charges
ICRC Exam Registration Instructions
Notices (Department Information)
This is required to take the Wisconsin Statutes and Rules exam.


Application for Out of State Reciprocity
Form #
Title
Instructions for Out of State Reciprocity Independent Clinical Supervisor Application
Application for Out of State Reciprocity Independent Clinical Supervisor
Convictions and Pending Charges
Notices (Department Information)
This is required to take the Wisconsin Statutes and Rules exam.