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DOCUMENTATION OF POST-GRADUATE CLINICAL EXPERIENCE SUPERVISORS AFFIDAVIT FOR

DOCUMENTATION OF POST-GRADUATE CLINICAL EXPERIENCE SUPERVISORS AFFIDAVIT FOR 2025

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The document is a form from the Wisconsin Department of Safety and Professional Services, specifically for the Marriage and Family Therapy, Professional Counseling, and Social Work Examining Board. It serves as an affidavit for social work license applicants to document their post-graduate clinical experience under a qualified supervisor. The form requires detailed information about the applicant's clinical hours, supervision details, and evaluations of their competencies in various areas of social work practice.

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Click ‘Get Form’ to open it in the editor.
Begin by entering the applicant’s name at the top of the form. Ensure accuracy as this will be used for official records.
Fill in the name and location of the post-graduate clinical experience facility. This provides context for the applicant's training.
Input the supervisor’s name and their credentials, including credential number, to validate their authority.
Specify the dates during which supervision occurred, ensuring to format them correctly (mm/yy).
Detail the number of hours of face-to-face client contact and supervision provided, as these are critical metrics for evaluation.
In the sections provided, describe your facility’s mission and clients served. This contextualizes the applicant's experience.
Answer detailed questions regarding the applicant’s therapy experience, DSM diagnosis involvement, and ability to recommend changes in diagnosis.
Complete the evaluation section by checking 'YES' or 'NO' for each competency area related to clinical skills.
Finally, sign and date the affidavit to certify that all information is true before submitting it through our platform.

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2022	4.8 Satisfied (47 Votes)
2017	4.1 Satisfied (30 Votes)

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Do LCSW make more than MSW?

Average National Salary Projections LCSWs working in specialized roles or private practice can earn over $95,000. The pay difference reflects LCSWs advanced clinical training and ability to practice independently. California serves as a good example, where LMSWs earn about $68,955, while LCSWs make $85,795 per year.

How many hours do you need for LCSW in Wisconsin?

Wisconsins social workers must renew their licenses every two years. To qualify for renewal, social workers complete 30 hours of continuing education during that period, including four hours of ethics and boundaries training. Social workers must submit their renewal applications and fees to the DSPS.

How to become a licensed clinical social worker in WI?

Licensed Clinical Social Worker A Master of Social Work (MSW) education with demonstrated clinical emphasis. A post-graduate, supervised clinical practice experience (3,000 or 4,500 hours) A Wisconsin Statutes and Administrative Code Examination.

What counts towards LCSW hours?

Clinical hours are the cornerstone of your LCSW training. These hands-on experiences are gained through direct work with clients in various settings such as hospitals, clinics, schools, or private practice. Most states require between 3,000 and 4,000 clinical hours, typically completed over a minimum of two years.

How to become an LCSW in Wisconsin?

Licensed Clinical Social Worker (LCSW) At least 3,000 hours of supervised experience. Passing score on the ASWB advanced generalist examination. Passing score on the Wisconsin social work jurisprudence exam.

How many supervised hours for LCSW in Wisconsin?

Upon completion of education and after receiving certification as an advanced practice social worker or as an independent social worker, engage in at least 3000 hours of supervised clinical social work practice, including at least 1,000 hours of face-to-face client contact and including DSM diagnosis and treatment of

DOCUMENTATION OF POST-GRADUATE CLINICAL EXPERIENCE SUPERVISORS AFFIDAVIT FOR 2025

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