Return all pages along with the $10 fee directly to the Office of the Professions at the address at the end of this form.ģ. Send the entire form along with a copy of Appendix A to your supervisor and have them complete Section II. Use the psychotherapy log to document your hours of practice and supervision.Ģ. In item 3, enter your name exactly as it appears on your Application for Licensure (FOrm 1). This form will not be reviewed if submitted after the supervised experience has been completed.ġ.
Prior to starting your supervised experience, you can verify the license status of your proposed supervisor on the Office of the Professions' web site at This form must be submitted prior to being employed or supervised by your proposed supervisor. The setting is responsible for employing the LMSW and the qualified supervisor to provide clinical social work services a LMSW cannot employ or contract with a supervisor.
It can show you the time you will require to finish blaĭivision of Professional Licensing ServicesĪpplication for Licensed Master Social WorkerĪ Licensed Master Social Worker (LMSW) must be registered to practice in New York State and may only provide clinical social work services, including psychotherapy, under the supervision of a Licensed Clinical Social Worker (LCSW), licensed psychologist or licensed physician who is board-certified in psychiatry in an authorized setting, as defined in Education Law and Commissioner's Regulations. You can find information about the type of form you would like to complete in the table. Any discrepancies discovered through reviewing this document can help organizations improve their overall workforce productivity. It is important to include all pertinent information on this form in order to accurately track employee hours. The form will list the name of the supervisor, as well as the department or work area where the employee is situated. Supervision hour forms are typically created by organizations following a set template.
In addition, the form can also be used as a basis for OHS training records. The form can be used to monitor employee productivity and ensure that all workplace policies and procedures are being followed. This document helps to track the amount of time employees spend under the direct supervision of their supervisor.
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