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Lcsw Form 4B. 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. Assigned number (from form 4):
Web before you accept a position practicing clinical social work. Licensed clinical social worker form 4, page 2 of 2, revised 8/17. 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. In item 3, enter your name exactly as it appears on your application for licensure (form 1). Be sure to sign and date item 8. Request your supervisor to submit verification of your supervised hours in diagnosis and psychotherapy on form 4b. Read the attached appendix a and complete all of section ii. Licensed master social worker (lmsw) licensed clinical social worker (lcsw) 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. Web be sure to sign and date item 10. Be sure to sign and date item 8. Web licensed clinical social worker. Web licensed clinical social worker form 4b certification of experience for licensed clinical social worker applicant instructions. 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: Licensed clinical social worker form 4, page 2 of 2, revised 8/17. 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. Web find form 2 here: Applicants must hast supervised experience approved in order to meet licensing eligibility.
