Lcsw Form 4B

Form GEN4B Download Printable PDF or Fill Online Registration of

Lcsw Form 4B. Applicants must hast supervised experience approved in order to meet licensing eligibility. Web find form 2 here:

Web licensed clinical social worker. You must also complete a separate form 4b for each supervised experience you list on the applicant experience record (form 4). Web find form 2 here: Web complete and submit this form, making sure to sign and date item 10; 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. 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. Assigned number (from form 4): This form must be submitted directly by your supervisor. Web be sure to sign and date item 10. Request your supervisor to submit verification of your supervised hours in diagnosis and psychotherapy on form 4b.

Be sure to complete a separate form 4b for each supervised experience listed on your applicant experience record (form 4). Licensed clinical social worker form 4, page 2 of 2, revised 8/17. Web licensed clinical social worker form 4b certification of experience for licensed clinical social worker instructions for completing section ii: Web complete and submit this form, making sure to sign and date item 10; 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. Web find form 2 here: The office of the professions will not accept this form if submitted by the applicant. You must also complete a separate form 4b for each supervised experience you list on the applicant experience record (form 4). This form must be submitted directly by your supervisor. Licensed master social worker (lmsw) licensed clinical social worker (lcsw)