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 CountyADRC of Barron and Rusk CountiesADRC of Brown CountyADRC of Buffalo and Pepin CountiesADRC of Calumet CountyADRC of Central Wisconsin (Marathon, Lincoln, Langlade and Wood Counties)ADRC 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 Green Lake CountyADRC of Jackson CountyADRC of Jefferson CountyADRC of Kenosha CountyADRC of La Crosse CountyADRC of the Lakeshore (Manitowoc and Kewaunee Counties)ADRC of Marinette CountyADRC of Marquette CountyADRC of Milwaukee CountyADRC of Monroe CountyADRC of the North (Ashland, Bayfield, Iron, Price, and Sawyer Counties)ADRC of Northwest Wisconsin (Burnett and Polk Counties)ADRC of the Northwoods (Forest County)ADRC 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, and Lafayette Counties)ADRC of St. Croix CountyADRC of Taylor 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 Waushara CountyADRC of Winnebago CountyADRC of the Wolf River Region (Shawano, Oconto and Menominee Counties, Stockbridge-Munsee Community)Tribal ADRS - Bad River Band of Lake Superior Tribe of Chippewa IndiansTribal ADRS - Forest County Potawatomi CommunityTribal ADRS - Ho Chunk NationTribal ADRS - Lac Courte Oreilles Band of Lake Superior Chippewa IndiansTribal ADRS - Lac du Flambeau Band of Lake Superior Chippewa IndiansTribal ADRS - Menominee Indian Tribe of WisconsinTribal ADRS - Oneida Tribe of Indians of WisconsinTribal ADRS - Red Cliff Band of Lake Superior Chippewa IndiansTribal ADRS - Sokaogon Chippewa Community – Mole Lake Band of Lake Superior ChippewaTribal ADRS - St. Croix Chippewa Indians of WisconsinArea Agency on Aging of Dane CountyAurora Medical GroupBoard on Aging and Long Term CareDouglas County Senior Connections • Marinette Elderly ServicesDRW - Disability Rights WisconsinFond du Lac County Senior ServicesGLITC - Great Lakes Inter-Tribal Council, Inc.GWAAR - Greater Wisconsin Agency on Aging Resources, Inc.JudicareMarinette Elderly ServicesOconto County Commission on AgingRock County Council on AgingSeniorLAW – Legal Action of WisconsinTaylor County Commission on AgingWI DHS – Office of Resource Center DevelopmentOtherName of OrganizationCommentThis field is hidden when viewing the formBrand CodePhoneThis field is for validation purposes and should be left unchanged.
