Lcsw Form 4B

NashSutcliffe efficiency of dissolved oxygen emulator vs simulator for

Lcsw Form 4B. 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 be sure to sign and date item 10.

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. Applicants must hast supervised experience approved in order to meet licensing eligibility. Web licensed clinical social worker. Be sure to complete a separate form 4b for each supervised experience listed on your applicant experience record (form 4). This form must be submitted directly by your supervisor. 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. 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. You must also complete a separate form 4b for each supervised experience you list on the applicant experience record (form 4).

Web complete and submit this form, making 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. Licensed clinical social worker form 4, page 2 of 2, revised 8/17. Assigned number (from form 4): Read the attached appendix a and complete all of section ii. The office of the professions will not accept this form if submitted by the applicant. Nysed office of the professions. Applicants must hast supervised experience approved in order to meet licensing eligibility. 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 before you accept a position practicing clinical social work. This form must be submitted directly by your supervisor.