Mental Health Counselor Form 4b Certification Of Supervised
Lcsw Form 4B. The office of the professions will not accept this form if submitted by the applicant. Request your supervisor to submit verification of your supervised hours in diagnosis and psychotherapy on form 4b.
Mental Health Counselor Form 4b Certification Of Supervised
Be sure to sign and date item 8. Read the attached appendix a and complete all of section ii. 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. Nysed office of the professions. Web be sure to sign and date item 10. The office of the professions will not accept this form if submitted by the applicant. Web licensed clinical social worker. Web find form 2 here: Licensed master social worker (lmsw) licensed clinical social worker (lcsw) Web before you accept a position practicing clinical social work.
Web find form 2 here: Web licensed clinical social worker. 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; In item 3, enter your name exactly as it appears on your application for licensure (form 1). Web find form 2 here: This form must be submitted directly by the supervisor. 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): Be sure to sign and date item 8. Read the attached appendix a and complete all of section ii.
