Mass Social Work License Application

Contents

1 Mass Social Work License Application

1.1 Licensed Social Worker Resume Samples

Mass Social Work License Application – 1 Massachusetts Commonwealth Social Worker Registration Board for Vocational Licensing c/o ASWB P.O. Box 1508 Culpeper, VA (866) Social Worker Relicensing Application Instructions For applicants previously licensed as a Social Worker in Massachusetts whose license has expired either: More than one year but less than two years More than two years General Information: Fees: The Association of Social Work Councils (ASWB) processes social work license applications on behalf of the Massachusetts Board of Social Worker Registration as authorized by the Office of Professional Licensing. Forms and fees must be sent to ASWB, Attn: Massachusetts Application, P.O. Box 1508, Culpeper, VA Do not mail forms to the Social Worker Registration Board. Please read these instructions carefully before completing the attached application forms. Licenses expired less than 1 year; contact the Social Workers Registration Board. Do not use this form. Relicensing applicants must follow the Title I or Title II process (described below). Enter or print information in blue or black ink. Illegible information can lead to delays. Please provide an answer for each information requested. Use N/A for questions that are not relevant. Your name MUST match the name on any valid government issued photo ID. Copies/fax of documents, certificates and attachments are not accepted. Incomplete applications or applications submitted without the appropriate fee will be returned. Make a copy of the completed application before submitting to ASWB. If you have any questions, please contact ASWB between 8:30 am and 5:00 pm. Eastern time, Monday through Friday, or in accordance with the application fees for applicants for re-license are indicated on page 7 of this application. The application fee must be filed with this application. License fees will be assessed and charged once the applicant has completed all examination and licensing requirements. If an exam is required, the ASWB exam registration fee will be assessed and collected at the time of exam registration. Accepted payment methods are certified check, money order or credit card (VISA, MasterCard or Discover). Please note that personal checks are not accepted. All fees are paid to ASWB in USD only, are non-refundable and subject to change. Applicant Information: I) Re-licensing requirements for applicants with a license that has expired more than one (1) year but less than two (2) years from the filing date of this application: circumstances in which a previous license expired. b) The Board reserves the right to request that candidates appear before the Board for further clarification. c) applicants must demonstrate compliance with the requirements of continuing education; a form of continuing education and CE documentation must be submitted with this application. The form is on page 9 of this application.

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2 d) Applicants holding a valid license or an expired license in another jurisdiction must submit a certified license confirmation form. The verification form must be in the original sealed envelope from the issuing jurisdiction. The form on page 8 may be used, or the issuing jurisdiction may use its own form. e) An official certified transcript is required if the previous license was originally issued before. Educational requirements are listed on page 3 of this application. The transcript must be in a sealed school envelope. Applicants will be notified by mail whether the application has been approved or not. Consolidated Checklist (Section I): Re-licensing applicants with a license term of more than one but less than two years must provide the following: An application signed and notarized (the date of signature must be the same as the date of notarization) Payment by certified check or cash order, payable ASWB; or credit card information Official transcript (if required) Certified license confirmation form from any current or previous jurisdiction (if applicable) Written explanation Continuing Education Form II) Re-licensing requirements for applicants with a license that has expired more than two (2) years from the date of submission of this application: a) you must pass the appropriate qualifying examination. Exam requirements are on page 3 of this appendix. b) Candidates cannot register for the exam until this application has been approved. c) Applicants who have taken and passed the ASWB exam for another jurisdiction within the past two years must indicate the date of the exam and request an officially certified ASWB score report ( ) from the ASWB. d) Applicants who hold a valid or expired license in another jurisdiction must submit a certified license verification form. The verification form must be in the original sealed envelope from the issuing jurisdiction. The form on page 8 may be used, or the issuing jurisdiction may use its own form. e) An official certified transcript is required if the previous license was originally issued before. Educational requirements are listed on page 3 of this application. The transcript must be in a sealed school envelope. f) If the exam requires special conditions, please contact the ASWB at address to request the appropriate forms. Application for accommodation for the disabled must be made to ASWB, Attn: CRC, P.O. Box 1508, Virginia. If approved, candidates will also receive ASWB exam registration information and a link to the ASWB Candidate Handbook that explains the procedure. Consolidated Checklist (Part II): Re-licensing applicants with a license that has expired more than 2 years must provide the following: An application signed and notarized (the date of signature must be the same as the date of notarization) Payment by certified check or money order to be payment in ASWB; or credit card information Official transcript (if required) Certified license validation form from each current or previous jurisdiction (if applicable) Pass the relevant ASWB exam or submit an officially certified ASWB score report if the exam was taken for another jurisdiction within the last two years Commonwealth of Massachusetts, Social Worker Registration Board, page 2 of 9

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Mass Social Work License Application

3 LICSW MSW, DSW or PhD in social work education from a CSWE accredited school of social work. applicants should review the detailed requirements in the Massachusetts regulations. Professional Research References Supervision Documented LCSW MSW, DSW or PhD experience in social work from a CSWE accredited school of social work. An LSW degree in social work from a CSWE accredited school of social work. working degree in any field Two and a half years (75 semesters / 100 part-time hours) of college Two years (60 semesters / 80 odd hours) of a college certificate from LICSW 2nd year of internship in the field Hold current LCSW (or equivalent); two years (3500 hours) of documented clinical experience after graduation from LCSW with 50 hours of face-to-face supervision per year (100 hours total) under LICSW Not required Not required Two years (3500 hours) of supervision experience after completing a BSW or TBT degree. Five years (8,750 hours) of BSW or MSW counseling experience Six years (10,500 hours) of BSW or MSW counseling experience One year (30 fs/80 hours) in people services. Bachelor’s degree (or 120 sem. hours / 160 working hours) in any field. High school diploma or equivalent. BSW or MSW Ten years (17,500 hours) of BSW or MSW counseling experience Not required Not required Not required Four years of documented social work registration experience page 3 of 9

Licensed Social Worker Resume Samples

4 Social Worker Relicensing Application Massachusetts Division of Professional Licensing Social Workers Registration Board c/o ASWB P.O. Box 1508 Culpeper, VA (866) Previous MA License: Type of Application: MA Previous Social Work License Number: MA Previous License Expiration Date: For licenses 1 to 2 years expired: Written explanation included? Is there an additional education form attached? For licenses over 2 years: Exam required. Are special conditions required? Licensed Independent Clinical Social Worker (LICSW) Licensed Certified Social Worker (LCSW) Licensed Social Worker (LSW) Licensed Social Worker (LSWA) License expired more than one but less than two years License expired more than two years Identification and Contact information (see instructions on page 2) Last name: First name: Middle name: If you have had a legal name change, please attach the relevant document confirming this fact. Maiden/other name: Date of birth: NOTE. Your Social Security number is required on page 7 of this application. NOTE. The mailing address below will be public. It will appear on your license and will be used for all Council correspondence. The mailing address and business address listed on page 5 may be the same. Mailing Address: Business Address: Commonwealth of Massachusetts, Social Workers Registration Board, page 4 of 9