Zoominfo cnorth-carolina-social-workNorth Carolina Social Work Certification and Licensure Board 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin with SECTION I, where you will input your name, LCSWA number, address, and place of employment. Ensure all fields are filled accurately.
3. Indicate whether your employment verification is attached or has already been submitted by checking the appropriate box.
4. In SECTION II, your clinical supervisor must acknowledge completion of required items by marking each bullet point with a checkmark or initials.
5. SECTION III requires the LCSW clinical supervisor to rate your performance across various competencies. Ensure this section is completed thoroughly.
6. Finally, in SECTION IV, the LCSW clinical supervisor must provide a narrative summary of your growth and participation in supervision. This section is mandatory for supervisors only.

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