Licensed Clinical Social Worker Form 4B Download Fillable PDF or Fill
Lcsw Form 4B. For your experience to be considered, you must also complete section i of form 4b and forward the entire form and a copy of appendix a to each supervisor you list in item 9 on this form. Nysed office of the professions.
Licensed Clinical Social Worker Form 4B Download Fillable PDF or Fill
Web be sure to sign and date item 10. Web find form 2 here: For your experience to be considered, you must also complete section i of form 4b and forward the entire form and a copy of appendix a to each supervisor you list in item 9 on this form. In item 3, enter your name exactly as it appears on your application for licensure (form 1). Web licensed clinical social worker form 4b certification of experience for licensed clinical social worker applicant instructions. Licensed clinical social worker form 4, page 2 of 2, revised 8/17. Licensed master social worker (lmsw) licensed clinical social worker (lcsw) Request your supervisor to submit verification of your supervised hours in diagnosis and psychotherapy on form 4b. The office of the professions will not accept this form if submitted by the applicant. Be sure to sign the affidavit and return the entire form directly to the office of the professions at the address at the end of this form.
Web licensed clinical social worker. Request your supervisor to submit verification of your supervised hours in diagnosis and psychotherapy on form 4b. This form must be submitted directly by the supervisor. In item 3, enter your name exactly as it appears on your application for licensure (form 1). Assigned number (from form 4): For your experience to be considered, you must also complete section i of form 4b and forward the entire form and a copy of appendix a to each supervisor you list in item 9 on this form. The office of the professions will not accept this form if submitted by the applicant. Be sure to sign and date item 8. You must also complete a separate form 4b for each supervised experience you list on the applicant experience record (form 4). Applicants must hast supervised experience approved in order to meet licensing eligibility. Web licensed clinical social worker form 4b certification of experience for licensed clinical social worker instructions for completing section ii:
