Application Status Query

Instructions: 

Please allow one hour after receipt of your status update email for the updates to be reflected in the online checklist.

Please verify the checklist information below, including your address. If your address has changed, please e-mail your application number, name, profession, along with your old and new address. The Credentialing department posts status information following receipt and review of application materials.

As of  :  10/30/2017
Application#  :  473766
Name  :  Bruns, Troy A
Profession  :  Intermediate Clinical Supervisor
Address  :  Eau Claire, WI
Application Status  :  Withdrawn (Abandoned)


Requirements Not Met:
Description Status Comments (Please note, not all requirements will include comments)
Affidavit regarding Supervised Counseling Experience Form Not Met
9/7/17: rec’d but missing fax cover page, print form 2777 at: http://dsps.wi.gov/Default.aspx?Page=ccc2512e-10a6-4afa-8bf4-7301ae28a42f - TH
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10/31/14: need form 2777, print form at: http://dsps.wi.gov/Default.aspx?Page=ccc2512e-10a6-4afa-8bf4-7301ae28a42f & mail to: Attn: Substance Abuse, DSPS, PO Box 8935, Madison WI 53708-8935
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6/11/13: submit form #2777
Affidavit regarding Supervisory Experience Form Not Met
9/7/17: rec’d but missing fax cover page, print form 2778 at: http://dsps.wi.gov/Default.aspx?Page=ccc2512e-10a6-4afa-8bf4-7301ae28a42f - TH
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10/31/14: need form 2778, print form at: http://dsps.wi.gov/Default.aspx?Page=ccc2512e-10a6-4afa-8bf4-7301ae28a42f & mail to: Attn: Substance Abuse, DSPS, PO Box 8935, Madison WI 53708-8935
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6/11/13: submit form #2778
Convictions and Pending Charges (Form #2252) Not Met
11/10/17: when application is complete it will be sent to paralegal for review – TH;
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10/26/17: need a Current Usage Statement; this statement will be about your relationship with drugs or alcohol today; - TH
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10/6/17: need personal statements, you may email these documents directly to: dspscredsubstanceabuse@wi.gov or mail to: Attn: Substance Abuse Counselor, DSPS, PO Box 8935, Madison WI 53708-8935; - TH
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in addition to the information above need a Current Usage Statement; this statement will be about your relationship with drugs or alcohol today; - TH
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PAID 9/19/17
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9/7/17: need $8.00 CIB Fee & form 2252 - TH
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12/30/14: Approved by Legal Counsel. KRE;
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12/19/14: rec’d fee, form, personal statement & supporting documents or statement regarding supporting documents. Your application has been sent to the paralegal for review. Applications are reviewed as promptly as possible, but review times do vary depending on a variety of factors. If further information is needed, you will be contacted. If a requirement hasn’t been updated, or you have not been contacted after 30 business days, you can contact a paralegal at DSPSCredParalegal@wi.gov or call (608)266-2112.
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PAID 12/2/14;
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10/31/14: need $8.00 CIB fee & rec'd copy of form 2252 need original, print form at: http://dsps.wi.gov/Default.aspx?Page=ccc2512e-10a6-4afa-8bf4-7301ae28a42f & mail to: Attn: Substance Abuse, DSPS, PO Box 8935, Madison WI 53708-8935
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Also send personal statement for each offense listed on form 2252 & supporting documents;
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12/20/13: rec'd form #2252 & document.
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submit completed form #2252 to DSPS and $8 CIB fee due to DSPS for CIB review. Please make out to DSPS. Also, NEED a personal statement regarding circumstances and information for each incident disclosed on form # 2252 AND any court-related documents regarding information disclosed on form #2252. Please mail documents and fee to: "DSPS, Substance

Requirements Met:
Description Status Comments (Please note, not all requirements will include comments)
ICRC Supervisor Examination Met
8/17/15: scores mailed;
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6/26/15: eligibility emailed, you will be sent a direct email from the testing company regarding how to sign up for the exam. It is important that you check your spam filters or the email from the testing company may be missed;
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6/11/15: You will be made eligible for the exam upon approval of your education;
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PAID 6/3/15;
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6/11/13: You will be approved to test after you have met the education requirement and paid the $115 exam fee.
Application Fee Met
PAID 9/19/17
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9/7/17: need $75.00 WI Statutes & Rules Exam Fee, mail to: Attn: Intermediate Clinical Supervisor, DSPS, PO Box 8935, Madison WI 53708-8935 - TH
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PAID 12/2/14;
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10/31/14: need $115.00 ICRC Written Exam fee;
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6/11/13: You may mail one check for $123 made out to "DSPS" with a copy of this application checklist to: "DSPS, Substance Abuse Section, PO Box 8935, Madison WI 53708."
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$115 due to DSPS for ICRC Exam, $8 due to DSPS for CIB fee.
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PAID 5/28/13 $233
Wisconsin Statutes and Rules Exam Met
10/30/17: complete; TH
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9/7/17: You took this exam on 3/15/10 for the CSIT which is over 5 years & you will need to retake this exam;
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You may take this exam at any time;
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Prior to taking exam, review instructions at:
http://dsps.wi.gov/Default.aspx?Page=bde1da42-ca20-4270-bb35-2c7131e05342
When at ParTest Online you’ll need the following:
Instructor: gsp
Test Name: SAP13A
Test Password: SAP13A
Student ID: 473766
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PLEASE NOTE: each attempt of this exam cost $75.00. If you receive a failing score you will be required to retake this exam & pay the $75.00 retake fee - TH
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CSIT 3/15/10
PAGE 1 Applicable blanks completed Met
10/6/17: complete; TH
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9/7/17: application is 1 year or older need update, print forms at: http://dsps.wi.gov/Default.aspx?Page=ccc2512e-10a6-4afa-8bf4-7301ae28a42f - TH
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12/19/14: complete;
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10/31/14: Application 1 year or older need update, print form 2744 at: http://dsps.wi.gov/Default.aspx?Page=ccc2512e-10a6-4afa-8bf4-7301ae28a42f & mail to: Attn: Substance Abuse, DSPS, PO Box 8935, Madison WI 53708-8935
PAGES 2 & 3 All questions answered and relevant copies attached Met
6/26/15: complete;
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6/11/15: rec'd page 3 where you answered question 7 as 'No' which is how you previously answered question 7; we need you to re-answer question 7, print page 3 of form 2744 at; http://dsps.wi.gov/Default.aspx?Page=ccc2512e-10a6-4afa-8bf4-7301ae28a42f & mail to: Attn: Substance Abuse, DSPS, PO Box 8935, Madison WI 53708-8935
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12/19/14: need question 7 re-answered, print page 3 of form 2744 at: http://dsps.wi.gov/Default.aspx?Page=ccc2512e-10a6-4afa-8bf4-7301ae28a42f & mail to: Attn: Substance Abuse, DSPS, PO Box 8935, Madison WI 53708-8935
Affidavit of applicant, signed Met
Social Security Number Met
Education and Training Form including proof of attendance and completion Met
6/26/15: complete;
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6/11/15: education out for review;
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12/19/14: need course descriptions for each course listed;
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10/31/14: Need proof of attendance, completion & course descriptions for each course listed; mail to: Attn: Substance Abuse, DSPS, PO Box 8935, Madison WI 53708-8935
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6/11/13: submit form #2776 with proof of completion of coursework
Certification of Legal Status Completed Met