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Swpr4 Certification of Experience for LCSW Psychotherapy R Privilege 2026
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- 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 LCSW Psychotherapy 'R' privilege in item 3. Ensure you complete your contact information accurately.
- Complete the remaining fields in Section I, including your New York State LCSW license number and the dates related to your licensure and M.S.W. degree.
- Once Section I is filled out, send the entire form along with Appendix A to your supervisor for completion of Section II.
- Ensure that your supervisor signs and returns the completed form directly to the Office of the Professions as specified.
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