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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Clinical Substance Abuse Counselor - Forms

(formerly Certified Alcohol and Drug Counselor III)

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 Clinical Substance Abuse Counselor Application
Application for Clinical Substance Abuse Counselor
Affidavit Regarding Supervised 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 Clinical Substance Abuse Counselor Application
Application for Out of State Reciprocity Clinical Substance Abuse Counselor
Convictions and Pending Charges
Notices (Department Information)
This is required to take the Wisconsin Statutes and Rules exam.