How to use or fill out form 4b lcsw with our platform
- Click ‘Get Form’ to open it in the editor.
- In Section I, enter your Social Security Number and Birth Date. If you do not have a U.S. Social Security Number, leave that field blank.
- Print your name exactly as it appears on your Application for Licensure in item 3. Ensure to sign and date item 8.
- Document your hours of practice and supervision using the psychotherapy log, which must be completed by both you and your supervisor.
- Send the entire form along with Appendix A to your supervisor for completion of Section II. Remember, this form cannot be submitted by you.
- In Section II, ensure your supervisor fills out their information accurately and certifies the supervised experience before returning the form directly to the Office of the Professions.
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