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Social Worker Licensed Clinical - Application Forms

Application for Exam, Initial Credential or Reciprocity (Temporary License not available for applicants licensed out-of-state.)
Form # Title/Description
2681  Licensed Clinical Social Worker Application 
2680  Licensed Clinical Social Worker Information for Application 
2673  Clinical Course Work for Social Work License (When submitting this form, you must also request a transcript directly from your school.  If your school is not UW or Loyola, you must provide course syllabi for psychopathology and two clinical courses)
2672  Documentation of Clinical Field Placement/Training For Social Work Licensure 
2560  Documentation of Post-Graduate Clinical Experience - Supervisor's Affidavit 
2771  Summary of Post-graduate Experience Hours for Clinical Social Work License (Submit with Form #2560)
2252 Convictions and Pending Charges 
2829 Malpractice Suits or Claims Form (If applicable)   
3071 Fax Payment Form
 
Application for Psychometric Testing
Form # Title/Description
2579  Affidavit of Supervisor in Support of Application to Engage in Psychometric Testing 
2578  Application to Engage in Psychometric Testing 
 
Application for Substance Abuse Speciality 
Form # Title/Description
2711 Application for Substance Abuse Specialty Authorization  
2712  Affidavit Regarding Supervised Experience for Substance Abuse Specialty Authorization 
2714  Substance Abuse Specialty Authorization Education and Training Form (For master degree applicants)
2713  Substance Abuse Specialty Authorization Education and Training Form (For bachelor degree applicants)

Other Information/Forms

Social Worker Licensed Clinical- License Information