Please fill out the form below. Fields marked with an asterisk* are required.
Please note: This is the Wisconsin version of EASy. If you are applying in another state, please be sure to select that state from the drop-down below.
Please use a personal email address (yahoo, gmail, etc.) as many agency email servers block emails from EASy.
Total number of years paid work experience with or on behalf of infants/toddlers and/or their families:
You may attach a resume or curriculum vitae. This is recommended if you have more than 3 relevant paid work experiences.
File should be in .PDF, .DOC, .DOCX or .RTF format
You must join or renew membership to WI-AIMH (or another infant mental health association) when submitting this preliminary application.
Please review and verify all data before submitting!