Fill Free fillable Lcsw4b Licensed Clinical Social Worker 4B PDF form
Lcsw Form 4B. Be sure to sign and date item 8. This form must be submitted directly by your supervisor.
Fill Free fillable Lcsw4b Licensed Clinical Social Worker 4B PDF form
In item 3, enter your name exactly as it appears on your application for licensure (form 1). Read the attached appendix a and complete all of section ii. This form must be submitted directly by your supervisor. Licensed master social worker (lmsw) licensed clinical social worker (lcsw) 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. 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. Web complete and submit this form, making sure to sign and date item 10; You must also complete a separate form 4b for each supervised experience you list on the applicant experience record (form 4).
Web before you accept a position practicing clinical social work. 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. 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 4, page 2 of 2, revised 8/17. Request your supervisor to submit verification of your supervised hours in diagnosis and psychotherapy on form 4b. Applicants must hast supervised experience approved in order to meet licensing eligibility. Web find form 2 here: The office of the professions will not accept this form if submitted by the applicant. Web before you accept a position practicing clinical social work.
