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University of Wisconsin Madison
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Please complete this form if you would like more information about what courses you will need to take to meet requirements for School Social Work licensure in the state of Wisconsin. Completed forms will be reviewed by our School Social Work Administration team and they will get back to you within five business days of the date of submission.

First Name
Last Name
Previous Last Name
Campus ID (
What is this? If you are a former UW Madison Student, this is your Campus ID when you were a student. This is not required, but helps the school provide accurate information based on your student record.
Address Line 1
Address Line 2
Are you currently working in a school as a School Social Worker or been offered a position as a School Social Worker?

Please indicate the School & District


MSW Program
Please indicate the course(s) you believe you may be exempt from. ALL NON-UW Madison students MUST submit a syllabus if requesting exemption on the basis of having taken an equivalent course. SW 644 Issues in Development Disabilities

(pdf only, <2MB)

SW 646 Child Abuse and Neglect

(pdf only, <2MB)

SW 612 Psychopathology in Generalist SW Practice

(pdf only, <2MB)

SW Practicum in School Setting

(pdf only, <2MB)

I don't believe I exempt from any of these courses
Please provide details of your field placement(s). Be sure to include the placement dates, agency/organization name, the name of your field supervisor, and a brief description of your role.


Transcript Upload
All Non-UW Madison students must submit a non-protected PDF transcript. Transcripts can be unofficial. Note that transcripts must be clear and easy to read, show the student's first and last name, the name of the institution attended and dates of attendance, degree conferred and the date of the degree conferral, if applicable. If in doubt, check with the institution's Registrar's Office.

(pdf only, <2MB)
Please upload a PDF of your resume or CV.

(pdf only, <2MB)
How did you hear about the UW-Madison post-MSW School Social Work option? (at least one is required) Word of mouth
UW-Madison School of Social Work website
Social Media
NASW newsletter
Email from UW-Madison School of Social Work
Wisconsin Department of Public Instruction (DPI)
Your school district/administrator

I agree that all information in this form is accurate to the best of my knowledge.

If you have questions about this form, please contact the school at (