Lcsw Form 4B

Fill Free fillable Lcsw4b Licensed Clinical Social Worker 4B PDF form

Lcsw Form 4B. You must also complete a separate form 4b for each supervised experience you list on the applicant experience record (form 4). Licensed master social worker (lmsw) licensed clinical social worker (lcsw)

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. Nysed office of the professions. Be sure to complete a separate form 4b for each supervised experience listed on your applicant experience record (form 4). In item 3, enter your name exactly as it appears on your application for licensure (form 1). Assigned number (from form 4): This form must be submitted directly by your supervisor. 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:

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). This form must be submitted directly by the supervisor. Request your supervisor to submit verification of your supervised hours in diagnosis and psychotherapy on form 4b. You must also complete a separate form 4b for each supervised experience you list on the applicant experience record (form 4). Be sure to sign and date item 8. Assigned number (from form 4): This form must be submitted directly by your supervisor. 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. Licensed master social worker (lmsw) licensed clinical social worker (lcsw) Web be sure to sign and date item 10.