ADRC Training Enrollment Form First Name* Last Name* Email*Be sure you have an active email address prior to enrolling. Enter Email Confirm Email Your Current Job Role* ADRC Specialist (Information and Assistance or Options Counselors, Dementia Care Specialists, etc.) Disability Benefits Specialist (DBS) Elder Benefits Specialist (EBS) Tribal ADRS Tribal DCS Tribal DBS Tribal EBS ADRC/ADRS Director / Manager / Supervisor ADRC Other (Support staff) ADRC Board Member Program/Supervising Attorney DHS Staff SHIP Counselor (Non-benefit specialist) Organization*Choose Your OrganizationADRC of Adams, Green Lake and Waushara CountiesADRC of Barron and Rusk CountiesADRC of Brown CountyADRC of Buffalo and Pepin CountiesADRC of Calumet CountyADRC of Central Wisconsin - Serving Marathon, Lincoln, Langlade and Wood CountiesADRC of Chippewa CountyADRC of Clark CountyADRC of Columbia CountyADRC of Dane CountyADRC of Dodge CountyADRC of Door CountyADRC of Douglas CountyADRC of Dunn CountyADRC of Eagle CountryADRC of Eau Claire CountyADRC of Florence CountyADRC of Fond du Lac CountyADRC of Jackson CountyADRC of Jefferson CountyADRC of Kenosha CountyADRC of La Crosse CountyADRC of the Lakeshore - Serving Manitowoc and Kewaunee CountiesADRC of Marinette CountyADRC of Marquette CountyADRC of Milwaukee CountyADRC of Monroe CountyADRC of the North - Ashland, Bayfield, Iron, Price, SawyerADRC of Northwest WisconsinADRC of the Northwoods - Serving Forest and Taylor Counties, Forest County Potawatomi, Lac du Flambeau and Sokaogon Chippewa TribesADRC of Oneida CountyADRC of Outagamie CountyADRC of Ozaukee CountyADRC of Pierce CountyADRC of Portage CountyADRC of Racine CountyADRC of Rock CountyADRC of Sauk CountyADRC of Sheboygan CountyADRC of Southwest Wisconsin - Grant, Green, Iowa, LafayetteADRC of St. Croix CountyADRC of Trempealeau CountyADRC of Vernon CountyADRC of Vilas CountyADRC of Walworth CountyADRC of Washburn CountyADRC of Washington CountyADRC of Waukesha CountyADRC of Waupaca CountyADRC of Winnebago CountyADRC of the Wolf River Region - Shawano, Oconto, Menominee Counties and the Stockbridge-Munsee CommunityArea Agency on Aging of Dane CountyTribal ADRS - Bad RiverTribal ADRS - Forest County PotawatomiTribal ADRS or EBS - Ho Chunk NationTribal ADRS - Lac Courte OrelliesTribal ADRS - Lac du FlambeauTribal ADRS or EBS – MenomineeTribal ADRS or EBS - OneidaTribal ADRS - Red CliffDRW - Disability Rights WisconsinGLITC - Great Lakes Inter-Tribal Council, Inc.GWAAR - Greater Wisconsin Agency on Aging Resources, Inc.WI DHS – Office of Resource Center DevelopmentJudicareSeniorLAW – Legal Action of WisconsinDouglas County Senior Connections • Marinette Elderly ServicesMarinette Elderly ServicesFond du Lac County Senior ServicesOconto County Commission on AgingRock County Council on AgingTaylor County Commission on AgingBoard on Aging and Long Term CareAurora Medical GroupOtherName of Organization CommentHiddenBrand Code PhoneThis field is for validation purposes and should be left unchanged.
