Lcsw Form 4B. Nysed office of the professions. Web licensed clinical social worker form 4b certification of experience for licensed clinical social worker applicant instructions.
Form 4B Updates YouTube
In item 3, enter your name exactly as it appears on your application for licensure (form 1). Assigned number (from form 4): Web find form 2 here: Licensed clinical social worker form 4, page 2 of 2, revised 8/17. The office of the professions will not accept this form if submitted by the applicant. 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). Web before you accept a position practicing clinical social work. Web licensed clinical social worker. Be sure to sign and date item 8.
Web be sure to sign and date item 10. This form must be submitted directly by your supervisor. Applicants must hast supervised experience approved in order to meet licensing eligibility. The office of the professions will not accept this form if submitted by the applicant. Web be sure to sign and date item 10. 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 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. Nysed office of the professions. Licensed master social worker (lmsw) licensed clinical social worker (lcsw) Assigned number (from form 4):
