New Jersey Division of Consumer Affairs - Newark, NJ 2026

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Click ‘Get Form’ to open it in the editor.
Begin by filling out the Supervisee Information section. Clearly print your last name, first name, and middle initial. Provide your complete address, daytime telephone number, email address, and Licensed Social Worker license number along with its active date.
Next, move to the Supervisor’s Information section. Enter the supervisor's details including their name, business name, and contact information. Ensure you answer the questions regarding licensure and training accurately.
Proceed to the Supervision Information section. Specify where client contact will occur and if supervision will take place at multiple locations. Answer all questions regarding supervision circumstances and objectives.
Finally, review all sections for accuracy before signing. Attach any required documents as specified in the Attachments section.

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