Mental Health Counselor Form 4b Certification Of Supervised
Lcsw Form 4B. Web be sure to sign and date item 10. Licensed clinical social worker form 4, page 2 of 2, revised 8/17.
Mental Health Counselor Form 4b Certification Of Supervised
Be sure to complete a separate form 4b for each supervised experience listed on your applicant experience record (form 4). Web licensed clinical social worker form 4b certification of experience for licensed clinical social worker applicant instructions. In item 3, enter your name exactly as it appears on your application for licensure (form 1). Applicants must hast supervised experience approved in order to meet licensing eligibility. This form must be submitted directly by the supervisor. This form must be submitted directly by your supervisor. Web licensed clinical social worker. Web complete and submit this form, making sure to sign and date item 10; Web find form 2 here: 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.
The office of the professions will not accept this form if submitted by the applicant. Nysed office of the professions. Web licensed clinical social worker form 4b certification of experience for licensed clinical social worker instructions for completing section ii: Web licensed clinical social worker form 4b certification of experience for licensed clinical social worker applicant instructions. 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). 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). Assigned number (from form 4): This form must be submitted directly by your supervisor. Licensed master social worker (lmsw) licensed clinical social worker (lcsw)
