Lcsw form 4b 2026

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The document is a form (Form 4B) used for the certification of experience required for licensure as a Licensed Clinical Social Worker (LCSW) in New York. It outlines the applicant's instructions for completing the form, including documenting supervised experience and client contact hours. The form requires verification from a licensed supervisor, detailing their qualifications and the nature of supervision provided. Additionally, it includes sections for both the applicant and supervisor to attest to the accuracy of the information provided, along with a psychotherapy log to track hours of practice.

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Click ‘Get Form’ to open the lcsw form 4b in the editor.
In Section I, enter your personal information. Ensure that your name matches exactly as it appears on your Application for Licensure (Form 1). Fill in your birth date and Social Security Number if applicable.
Complete the contact details including your telephone number and email address. Make sure to provide a current mailing address.
Document your supervised experience in item 6. Include the name of your clinical supervisor, their license number, and the setting where you provided services.
Sign and date item 7 to affirm that all information is accurate. This step is crucial for the validity of your application.
Once Section I is complete, send the form to your supervisor for them to fill out Section II. They must sign and notarize their section before submission.

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2020	4.2 Satisfied (24 Votes)
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How many hours of supervision for LCSW in Maryland?

If the applicant has obtained less than the required thousand (3000) hours of post- masters or postdoctoral experience, the applicant must obtain the remaining hours in or out of the District of Columbia before he or she will be granted licensure.

What counts as clinical hours for LCSW NJ?

Certified Social Worker-Clinical (LCSW-C) shall have: Obtained at least two years, consisting of not less than 104 weeks, of at least 3,000 hours of supervised clinical social work experience in direct service to clients.

What counts as clinical hours for LCSW Illinois?

Licensed Clinical Social Worker (LCSW) At least 1,920 hours of the 3,000 hours shall be in face-to-face client contact, and half of these 1,920 hours shall be in psychotherapeutic counseling. The other 1,080 hours can include time spent in supervision or other social work services.

How to document clinical hours for LCSW?

Use a digital or paper-based method, but ensure it includes these key fields: Date: Record the date of each session or work period. Hours Worked: Note the number of hours you spent on clinical tasks. Supervision Type: Specify whether it was individual or group supervision.

What do you need for LCSW in NY?

New York licensure requirements for LCSW include: Masters degree in social work. Current, active LMSW license in New York. At least three years of supervised postgraduate experience in diagnosis, psychotherapy and assessment-based treatment planning, in a workplace legally authorized to provide these services.

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How many hours of supervision do you need for LCSW NY?

The supervision must consist of at least 100 hours of in-person individual or group clinical supervision distributed over the period of the supervised experience.

What are the requirements for LCSW supervision in Texas?

All in state candidates must complete the following in no less than 24 months and no more than 48 months: 3,000 hours of supervised practice 100 hours of direct supervision A licensed master social worker should contact a board approved supervisor to set up a supervisory relationship.

Lcsw form 4b 2026

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