Thank you for taking an interest in becoming an ERC affiliate provider. For consideration, please complete this affiliate application and fax it to 920-403-7360.
Individuals who hold a Master's degree in Social Work, Counseling, or related field and have a state license may see ERC referrals.
If you have any questions or concerns, please contact either Lisa Malcore, Regional Affiliate Coordinator, or Gail Knight, Assistant Regional Coordinator, at 1-800-222-8590.
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